Table 2.
Pooled HRs (95% CIs) of mortality for low-carbohydrate scores among participants with T2D in NHS (1980–2018) and HPFS (1986–2018)
| Q1 | Q2 | Q3 | Q4 | Q5 | P trend | Per 10 points | |
|---|---|---|---|---|---|---|---|
| All-cause mortality | |||||||
| TLCDS | |||||||
| Median score | 9.5 | 14.5 | 18.0 | 21.2 | 25.5 | ||
| Cases/person-years | 1,198/28,193 | 1,054/27,635 | 864/28,259 | 839/27,633 | 640/27,687 | — | — |
| Age-adjusted model | 1 | 0.99 (0.91, 1.08) | 0.88 (0.81, 0.97) | 0.96 (0.88, 1.06) | 0.84 (0.76, 0.93) | <0.01 | 0.92 (0.88, 0.97) |
| Multivariable-adjusted model | 1 | 0.91 (0.83, 1.00) | 0.77 (0.70, 0.85) | 0.89 (0.81, 0.99) | 0.77 (0.69, 0.85) | <0.0001 | 0.87 (0.82, 0.92) |
| ALCDS | |||||||
| Median score | 8.5 | 14.0 | 18.0 | 21.8 | 26.0 | ||
| Cases/person-years | 1,035/27,598 | 1,006/27,737 | 984/28,360 | 836/28,323 | 734/27,388 | — | — |
| Age-adjusted model | 1 | 1.07 (0.98, 1.18) | 1.11 (1.01, 1.21) | 1.05 (0.95, 1.15) | 1.07 (0.97, 1.18) | 0.15 | 1.04 (0.99, 1.09) |
| Multivariable-adjusted model | 1 | 0.94 (0.85, 1.03) | 0.94 (0.85, 1.03) | 0.92 (0.83, 1.01) | 0.91 (0.82, 1.01) | 0.04 | 0.95 (0.90, 1.00) |
| VLCDS | |||||||
| Median score | 10.0 | 13.3 | 16.0 | 18.8 | 22.7 | ||
| Cases/person-years | 1,200/27,718 | 1,030/27,390 | 973/28,172 | 802/28,104 | 590/28,022 | — | — |
| Age-adjusted model | 1 | 0.93 (0.86, 1.02) | 0.95 (0.87, 1.04) | 0.80 (0.73, 0.88) | 0.65 (0.58, 0.72) | <0.0001 | 0.75 (0.70, 0.79) |
| Multivariable-adjusted model | 1 | 0.93 (0.85, 1.02) | 0.88 (0.80, 0.96) | 0.79 (0.72, 0.88) | 0.70 (0.63, 0.78) | <0.0001 | 0.76 (0.71, 0.82) |
| ULCDS | |||||||
| Median score | 8.0 | 13.3 | 17.0 | 20.0 | 24.5 | ||
| Cases/person-years | 970/28,212 | 998/27,406 | 938/28,369 | 883/27,673 | 806/27,745 | — | — |
| Age-adjusted model | 1 | 1.17 (1.07, 1.28) | 1.15 (1.05, 1.27) | 1.20 (1.09, 1.32) | 1.25 (1.13, 1.38) | <0.0001 | 1.13 (1.07, 1.18) |
| Multivariable-adjusted model | 1 | 1.07 (0.97, 1.18) | 1.02 (0.92, 1.13) | 1.03 (0.93, 1.14) | 1.06 (0.95, 1.18) | 0.52 | 1.02 (0.96, 1.08) |
| HLCDS | |||||||
| Median score | 10.0 | 13.7 | 16.0 | 19.0 | 23.0 | ||
| Cases/person-years | 1,046/27,351 | 1,015/28,609 | 995/27,430 | 888/28,414 | 651/27,601 | — | — |
| Age-adjusted model | 1 | 0.95 (0.86, 1.04) | 0.95 (0.86, 1.04) | 0.83 (0.75, 0.91) | 0.62 (0.56, 0.69) | <0.0001 | 0.74 (0.70, 0.78) |
| Multivariable-adjusted model | 1 | 0.92 (0.84, 1.01) | 0.91 (0.83, 1.00) | 0.83 (0.75, 0.92) | 0.71 (0.63, 0.79) | <0.0001 | 0.78 (0.73, 0.84) |
| CVD mortality | |||||||
| TLCDS | |||||||
| Median score | 9.5 | 14.5 | 18.0 | 21.2 | 25.5 | ||
| Cases/person-years | 378/28,193 | 309/27,635 | 250/28,259 | 253/27,633 | 199/27,687 | — | — |
| Age-adjusted model | 1 | 0.94 (0.81, 1.11) | 0.89 (0.76, 1.06) | 1.00 (0.84, 1.18) | 0.95 (0.79, 1.14) | 0.48 | 0.97 (0.88, 1.06) |
| Multivariable-adjusted model | 1 | 0.85 (0.72, 1.00) | 0.77 (0.65, 0.92) | 0.91 (0.76, 1.09) | 0.86 (0.71, 1.04) | 0.04 | 0.90 (0.82, 1.00) |
| ALCDS | |||||||
| Median score | 8.5 | 14.0 | 18.0 | 21.8 | 26.0 | ||
| Cases/person-years | 319/27,598 | 312/27,737 | 288/28,360 | 246/28,323 | 224/27,388 | — | — |
| Age-adjusted model | 1 | 1.14 (0.96, 1.34) | 1.11 (0.94, 1.32) | 1.08 (0.91, 1.28) | 1.17 (0.98, 1.41) | 0.20 | 1.06 (0.97, 1.15) |
| Multivariable-adjusted model | 1 | 0.94 (0.79, 1.12) | 0.94 (0.79, 1.12) | 0.90 (0.75, 1.08) | 0.97 (0.81, 1.18) | 0.33 | 0.96 (0.87, 1.05) |
| VLCDS | |||||||
| Median score | 10.0 | 13.3 | 16.0 | 18.8 | 22.7 | ||
| Cases/person-years | 357/27,718 | 297/27,390 | 312/28,172 | 270/28,104 | 153/28,022 | — | — |
| Age-adjusted model | 1 | 0.96 (0.81, 1.12) | 1.12 (0.95, 1.32) | 1.00 (0.85, 1.18) | 0.63 (0.52, 0.77) | <0.001 | 0.81 (0.72, 0.90) |
| Multivariable-adjusted model | 1 | 0.94 (0.80, 1.11) | 1.03 (0.87, 1.22) | 1.00 (0.84, 1.20) | 0.69 (0.56, 0.85) | <0.01 | 0.84 (0.74, 0.95) |
| ULCDS | |||||||
| Median score | 8.0 | 13.3 | 17.0 | 20.0 | 24.5 | ||
| Cases/person-years | 305/28,212 | 317/27,406 | 276/28,369 | 255/27,673 | 236/27,745 | — | — |
| Age-adjusted model | 1 | 1.17 (0.99, 1.38) | 1.07 (0.90, 1.27) | 1.12 (0.94, 1.34) | 1.23 (1.03, 1.47) | 0.03 | 1.11 (1.01, 1.21) |
| Multivariable-adjusted model | 1 | 1.04 (0.88, 1.24) | 0.92 (0.77, 1.10) | 0.93 (0.77, 1.12) | 1.01 (0.83, 1.23) | 0.74 | 0.98 (0.89, 1.09) |
| HLCDS | |||||||
| Median score | 10.0 | 13.7 | 16.0 | 19.0 | 23.0 | ||
| Cases/person-years | 303/27,351 | 314/28,609 | 295/27,430 | 287/28,414 | 190/27,601 | — | — |
| Age-adjusted model | 1 | 1.01 (0.86, 1.19) | 0.99 (0.83, 1.17) | 0.93 (0.79, 1.11) | 0.66 (0.55, 0.80) | <0.0001 | 0.79 (0.70, 0.88) |
| Multivariable-adjusted model | 1 | 0.98 (0.82, 1.17) | 0.96 (0.81, 1.15) | 0.93 (0.78, 1.12) | 0.79 (0.64, 0.97) | 0.02 | 0.86 (0.75, 0.97) |
| Cancer mortality | |||||||
| TLCDS | |||||||
| Median score | 9.5 | 14.5 | 18.0 | 21.2 | 25.5 | ||
| Cases/person-years | 180/28,193 | 202/27,635 | 161/28,259 | 194/27,633 | 144/27,687 | — | — |
| Age-adjusted model | 1 | 1.16 (0.94, 1.43) | 0.97 (0.78, 1.21) | 1.28 (1.03, 1.59) | 0.98 (0.77, 1.23) | 0.62 | 1.03 (0.92, 1.16) |
| Multivariable-adjusted model | 1 | 1.11 (0.89, 1.37) | 0.94 (0.75, 1.17) | 1.27 (1.02, 1.59) | 0.92 (0.72, 1.16) | 0.98 | 1.00 (0.89, 1.13) |
| ALCDS | |||||||
| Median score | 8.5 | 14.0 | 18.0 | 21.8 | 26.0 | ||
| Cases/person-years | 168/27,598 | 178/27,737 | 186/28,360 | 186/28,323 | 163/27,388 | — | — |
| Age-adjusted model | 1 | 1.05 (0.84, 1.31) | 1.17 (0.94, 1.45) | 1.24 (1.00, 1.54) | 1.18 (0.94, 1.48) | 0.03 | 1.13 (1.01, 1.26) |
| Multivariable-adjusted model | 1 | 1.02 (0.82, 1.28) | 1.08 (0.86, 1.35) | 1.19 (0.95, 1.49) | 1.06 (0.84, 1.35) | 0.27 | 1.06 (0.95, 1.19) |
| VLCDS | |||||||
| Median score | 10.0 | 13.3 | 16.0 | 18.8 | 22.7 | ||
| Cases/person-years | 220/27,718 | 187/27,390 | 184/28,172 | 149/28,104 | 141/28,022 | — | — |
| Age-adjusted model | 1 | 0.91 (0.75, 1.12) | 0.94 (0.76, 1.15) | 0.73 (0.59, 0.91) | 0.73 (0.58, 0.91) | <0.001 | 0.77 (0.67, 0.88) |
| Multivariable-adjusted model | 1 | 0.96 (0.78, 1.18) | 0.92 (0.74, 1.14) | 0.77 (0.61, 0.96) | 0.80 (0.64, 1.01) | <0.01 | 0.80 (0.69, 0.93) |
| ULCDS | |||||||
| Median score | 8.0 | 13.3 | 17.0 | 20.0 | 24.5 | ||
| Cases/person-years | 162/28,212 | 177/27,406 | 172/28,369 | 186/27,673 | 184/27,745 | — | — |
| Age-adjusted model | 1 | 1.15 (0.92, 1.44) | 1.13 (0.91, 1.42) | 1.33 (1.07, 1.66) | 1.41 (1.13, 1.76) | <0.001 | 1.21 (1.08, 1.36) |
| Multivariable-adjusted model | 1 | 1.09 (0.87, 1.37) | 1.05 (0.83, 1.32) | 1.20 (0.95, 1.51) | 1.23 (0.97, 1.56) | 0.06 | 1.12 (0.99, 1.27) |
| HLCDS | |||||||
| Median score | 10.0 | 13.7 | 16.0 | 19.0 | 23.0 | ||
| Cases/person-years | 197/27,351 | 188/28,609 | 182/27,430 | 178/28,414 | 136/27,601 | — | — |
| Age-adjusted model | 1 | 0.89 (0.72, 1.10) | 0.93 (0.75, 1.15) | 0.85 (0.69, 1.06) | 0.66 (0.52, 0.82) | <0.0001 | 0.75 (0.66, 0.86) |
| Multivariable-adjusted model | 1 | 0.90 (0.72, 1.11) | 0.96 (0.77, 1.19) | 0.92 (0.73, 1.14) | 0.77 (0.60, 0.98) | 0.02 | 0.83 (0.72, 0.96) |
Age (years)– and calendar year–stratified Cox model adjusted for race (White, African American, Asian, others), total energy (quintile), physical activity (quintile), alcohol intake (0, 0.1–4.9, 5.0–9.9, 10.0–14.9, 15.0–29.9, and ≥30.0 g/d), prediagnosis AHEI (quintile), smoking status (never smoked; past smoker; currently smoke 1–14 cigarettes per day, 15–24 cigarettes per day, or ≥25 cigarettes per day), prediagnosis BMI (<21.0, 21.0–22.9, 23.0–24.9, 25.0–26.9, 27.0–29.9, 30.0–32.9, 33.0–34.9, or ≥35.0 kg/m2), multivitamin use (yes, no), family history of diabetes (yes, no), family history of myocardial infarction (yes, no), family history of cancer (yes, no), diabetes duration (0–5 years, 5–10 years, 10–15 years, >15 years), time interval between diagnosis date and latest postdiagnosis FFQ return date (months), postmenopausal hormone use (women only; premenopausal, never, former, current, or missing), oral hypoglycemic drug use (women only; yes, no), and insulin use (women only; yes, no). Q, quintile.