The reference level is 46·4% energy from carbohydrate. ARIC results are adjusted for age, sex, education, waist-to-hip ratio, smoking, physical activity, diabetes, ARIC test centre, and energy intake. PURE results are are adjusted for age, sex, education, waist-to-hip ratio, smoking, physical activity, diabetes, urban or rural location, centre, geographical regions, and energy intake.13 The mean percentage of energy from carbohydrate in ARIC is 49%, and from PURE it is 61%. ARIC=Atherosclerosis Risk in Communities. PURE=Prospective Urban Rural Epidemiology.