Low-carbohydrate, high-protein diet score and risk of incident cancer; a prospective cohort study

Nutrition Journal

Bethany Van Guelpen¹  Per Lenner³  Göran Hallmans⁵  Bernt Lindahl⁵  Ingegerd Johansson²  Anna Winkvist⁴  Lena Maria Nilsson⁶ 

[1] Department of Medical Biosciences, Pathology, Umeå University, Umeå SE-90185, Sweden;Department of Odontology, Umeå University, Umeå SE-90185, Sweden;Department of Oncology and Radiation Sciences, Oncological Center, Umeå University, Umeå SE-90185, Sweden;Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Göteborg SE-40530, Sweden;Department of Public Health and Clinical Medicine, Umeå University, Umeå SE-90185, Sweden;Department of Public Health and Clinical Medicine,Nutritional Research, Umeå University, Umeå SE-90185, Sweden

关键词: Cohort study;    Fat intake;    Protein intake;    Carbohydrate intake;    Macronutrients;    Cancer;    Diet;   

Others  :  806840
DOI  :  10.1186/1475-2891-12-58

 received in 2013-02-12, accepted in 2013-05-02,  发布年份 2013

【 摘 要 】

Background

Although carbohydrate reduction of varying degrees is a popular and controversial dietary trend, potential long-term effects for health, and cancer in specific, are largely unknown.

Methods

We studied a previously established low-carbohydrate, high-protein (LCHP) score in relation to the incidence of cancer and specific cancer types in a population-based cohort in northern Sweden. Participants were 62,582 men and women with up to 17.8 years of follow-up (median 9.7), including 3,059 prospective cancer cases. Cox regression analyses were performed for a LCHP score based on the sum of energy-adjusted deciles of carbohydrate (descending) and protein (ascending) intake labeled 1 to 10, with higher scores representing a diet lower in carbohydrates and higher in protein. Important potential confounders were accounted for, and the role of metabolic risk profile, macronutrient quality including saturated fat intake, and adequacy of energy intake reporting was explored.

Results

For the lowest to highest LCHP scores, 2 to 20, carbohydrate intakes ranged from median 60.9 to 38.9% of total energy intake. Both protein (primarily animal sources) and particularly fat (both saturated and unsaturated) intakes increased with increasing LCHP scores. LCHP score was not related to cancer risk, except for a non-dose-dependent, positive association for respiratory tract cancer that was statistically significant in men. The multivariate hazard ratio for medium (9–13) versus low (2–8) LCHP scores was 1.84 (95% confidence interval: 1.05-3.23; p-trend = 0.38). Other analyses were largely consistent with the main results, although LCHP score was associated with colorectal cancer risk inversely in women with high saturated fat intakes, and positively in men with higher LCHP scores based on vegetable protein.

Conclusion

These largely null results provide important information concerning the long-term safety of moderate carbohydrate reduction and consequent increases in protein and, in this cohort, especially fat intakes. In order to determine the effects of stricter carbohydrate restriction, further studies encompassing a wider range of macronutrient intakes are warranted.

【 授权许可】

   
2013 Nilsson et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Mann J, Nye ER: Fad diets in sweden, of all places. Lancet 2009, 374:767-769.
• [2]Johansson I, Nilsson L, Stegmayr B, Boman K, Hallmans G, Winkvist A: Associations among 25-year trends in diet, cholesterol and BMI from 140,000 observations in men and women in northern sweden. Nutr J 2012, 11:40. BioMed Central Full Text
• [3]Ng N, Johnson O, Lindahl B, Norberg M: A reversal of decreasing trends in population cholesterol levels in vasterbotten county, sweden. Glob Health Action 2012., 5
• [4]Volek J, Sharman M, Gomez A, Judelson D, Rubin M, Watson G, Sokmen B, Silvestre R, French D, Kraemer W: Comparison of energy-restricted very low-carbohydrate and low-fat diets on weight loss and body composition in overweight men and women. Nutr Metab (Lond) 2004, 1:13. BioMed Central Full Text
• [5]Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton SD, McManus K, Champagne CM, Bishop LM, Laranjo N: Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med 2009, 360:859-873.
• [6]Samaha FF, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, Williams T, Williams M, Gracely EJ, Stern L: A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med 2003, 348:2074-2081.
• [7]Katan MB: Weight-loss diets for the prevention and treatment of obesity. N Engl J Med 2009, 360:923-925.
• [8]Layman DK, Clifton P, Gannon MC, Krauss RM, Nuttall FQ: Protein in optimal health: heart disease and type 2 diabetes. Am J Clin Nutr 2008, 87:1571S-1575S.
• [9]Hession M, Rolland C, Kulkarni U, Wise A, Broom J: Systematic review of randomized controlled trials of low-carbohydrate vs. low-fat/low-calorie diets in the management of obesity and its comorbidities. Obes Rev 2009, 10:36-50.
• [10]Kirk JK, Graves DE, Craven TE, Lipkin EW, Austin M, Margolis KL: Restricted-carbohydrate diets in patients with type 2 diabetes: a meta-analysis. J Am Diet Assoc 2008, 108:91-100.
• [11]Ebbeling CB, Swain JF, Feldman HA, Wong WW, Hachey DL, Garcia-Lago E, Ludwig DS: Effects of dietary composition on energy expenditure during weight-loss maintenance. JAMA 2012, 307:2627-2634.
• [12]Stimson RH, Johnstone AM, Homer NZ, Wake DJ, Morton NM, Andrew R, Lobley GE, Walker BR: Dietary macronutrient content alters cortisol metabolism independently of body weight changes in obese men. J Clin Endocrinol Metab 2007, 92:4480-4484.
• [13]Rankin JW, Turpyn AD: Low carbohydrate, high fat diet increases C-reactive protein during weight loss. J Am Coll Nutr 2007, 26:163-169.
• [14]Tete S, Nicoletti M, Saggini A, Maccauro G, Rosati M, Conti F, Cianchetti E, Tripodi D, Toniato E, Fulcheri M: Nutrition and cancer prevention. Int J Immunopathol Pharmacol 2012, 25:573-581.
• [15]Fung TT, van Dam RM, Hankinson SE, Stampfer M, Willett WC, Hu FB: Low-carbohydrate diets and all-cause and cause-specific mortality: two cohort studies. Ann Intern Med 2010, 153:289-298.
• [16]Trichopoulou A, Psaltopoulou T, Orfanos P, Hsieh CC, Trichopoulos D: Low-carbohydrate-high-protein diet and long-term survival in a general population cohort. Eur J Clin Nutr 2007, 61:575-581.
• [17]Lagiou P, Sandin S, Weiderpass E, Lagiou A, Mucci L, Trichopoulos D, Adami HO: Low carbohydrate-high protein diet and mortality in a cohort of swedish women. J Intern Med 2007, 261:366-374.
• [18]Sjogren P, Becker W, Warensjo E, Olsson E, Byberg L, Gustafsson IB, Karlstrom B, Cederholm T: Mediterranean and carbohydrate-restricted diets and mortality among elderly men: a cohort study in sweden. Am J Clin Nutr 2010, 92:967-974.
• [19]Nilsson LM, Winkvist A, Eliasson M, Jansson JH, Hallmans G, Johansson I, Lindahl B, Lenner P, Van Guelpen B: Low-carbohydrate, high-protein score and mortality in a northern swedish population-based cohort. Eur J Clin Nutr 2012, 66(6):694-700. Epub 2012/02/16
• [20]Lagiou P, Sandin S, Lof M, Trichopoulos D, Adami HO, Weiderpass E: Low carbohydrate-high protein diet and incidence of cardiovascular diseases in swedish women: prospective cohort study. BMJ 2012, 344:e4026.
• [21]Halton TL, Willett WC, Liu S, Manson JE, Albert CM, Rexrode K, Hu FB: Low-carbohydrate-diet score and the risk of coronary heart disease in women. N Engl J Med 2006, 355:1991-2002.
• [22]Kelemen LE, Kushi LH, Jacobs DR Jr, Cerhan JR: Associations of dietary protein with disease and mortality in a prospective study of postmenopausal women. Am J Epidemiol 2005, 161:239-249.
• [23]Schulz M, Hoffmann K, Weikert C, Nothlings U, Schulze MB, Boeing H: Identification of a dietary pattern characterized by high-fat food choices associated with increased risk of breast cancer: the european prospective investigation into cancer and nutrition (EPIC)-potsdam study. Br J Nutr 2008, 100:942-946.
• [24]Fung TT, Hu FB, Hankinson SE, Willett WC, Holmes MD: Low-Carbohydrate Diets, Dietary Approaches to Stop Hypertension-Style Diets, and the Risk of Postmenopausal Breast Cancer. Am J Epidemiol 2011, 174(6):652-660. Epub 2011/08/13
• [25]Weinehall L, Hellsten G, Boman K, Hallmans G: Prevention of cardiovascular disease in sweden: the norsjo community intervention programme–motives, methods and intervention components. Scand J Public Health Suppl 2001, 56:13-20.
• [26]Winkvist A, Hornell A, Hallmans G, Lindahl B, Weinehall L, Johansson I: More distinct food intake patterns among women than men in northern sweden: a population-based survey. Nutr J 2009, 8:12. BioMed Central Full Text
• [27]Johansson I, Hallmans G, Wikman A, Biessy C, Riboli E, Kaaks R: Validation and calibration of food-frequency questionnaire measurements in the northern sweden health and disease cohort. Public Health Nutr 2002, 5:487-496.
• [28]Wennberg M, Vessby B, Johansson I: Evaluation of relative intake of fatty acids according to the northern sweden FFQ with fatty acid levels in erythrocyte membranes as biomarkers. Public Health Nutr 2009, 12:1477-1484.
• [29]Johansson I, Van Guelpen B, Hultdin J, Johansson M, Hallmans G, Stattin P: Validity of food frequency questionnaire estimated intakes of folate and other B vitamins in a region without folic acid fortification. Eur J Clin Nutr 2010, 64:905-913.
• [30]Pukkala E, Andersen A, Berglund G, Gislefoss R, Gudnason V, Hallmans G, Jellum E, Jousilahti P, Knekt P, Koskela P: Nordic biological specimen banks as basis for studies of cancer causes and control–more than 2 million sample donors, 25 million person years and 100,000 prospective cancers. Acta Oncol 2007, 46:286-307.
• [31]Weinehall L, Hallgren CG, Westman G, Janlert U, Wall S: Reduction of selection bias in primary prevention of cardiovascular disease through involvement of primary health care. Scand J Prim Health Care 1998, 16:171-176.
• [32]Percy C: International classification of diseases for oncology: ICD-O. Geneva: World Health Organization; 1990.
• [33]Nilsson LM: Sami lifestyle and health [elektronisk resurs] : epidemiological studies from northern sweden. Umeå: Umeå university; 2012.
• [34]Willett W, Stampfer MJ: Total energy intake: implications for epidemiologic analyses. Am J Epidemiol 1986, 124:17-27.
• [35]WCRF, AIRC: World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR; 2007:284. Available at url: http://eprints.ucl.ac.uk/4841/1/4841.pdf webcite, accessed January 20132011
• [36]Ross SA: Evidence for the relationship between diet and cancer. Exp Oncol 2010, 32:137-142.
• [37]Klement RJ, Kammerer U: Is there a role for carbohydrate restriction in the treatment and prevention of cancer? Nutr Metab (Lond) 2011, 8:75. BioMed Central Full Text
• [38]Cowey S, Hardy RW: The metabolic syndrome: a high-risk state for cancer? Am J Pathol 2006, 169:1505-1522.
• [39]Abete I, Astrup A, Martinez JA, Thorsdottir I, Zulet MA: Obesity and the metabolic syndrome: role of different dietary macronutrient distribution patterns and specific nutritional components on weight loss and maintenance. Nutr Rev 2010, 68:214-231.
• [40]Russell WR, Gratz SW, Duncan SH, Holtrop G, Ince J, Scobbie L, Duncan G, Johnstone AM, Lobley GE, Wallace RJ: High-protein, reduced-carbohydrate weight-loss diets promote metabolite profiles likely to be detrimental to colonic health. Am J Clin Nutr 2011, 93:1062-1072.
• [41]Ferreira LM, Hebrant A, Dumont JE: Metabolic reprogramming of the tumor. Oncogene 2012, 31:3999-4011.
• [42]Weinehall L, Westman G, Hellsten G, Boman K, Hallmans G, Pearson TA, Wall S: Shifting the distribution of risk: results of a community intervention in a swedish programme for the prevention of cardiovascular disease. J Epidemiol Community Health 1999, 53:243-250.
• [43]Marcus C, Hallmans G, Johansson G, Rothenberg E, Rossner S: [High-fat diet intake can be questioned]. Lakartidningen 2008, 105:1864-1866.