Association between low‐carbohydrate diet scores and macrovascular events or all‐cause mortality in adults with type 1 diabetes in Japan

Abstract

ABSTRACT Aims/Introduction The effects of lifestyle factors on macrovascular events or all‐cause mortality remain unclear in type 1 diabetes. We examined the associations of diet, physical activity, and sleep with these outcomes among adults with type 1 diabetes living in Japan. Materials and Methods This multicenter prospective cohort included 352 adults with type 1 diabetes from the Juntendo–Aso Type 1 Diabetes cohort. Lifestyle factors were assessed by questionnaire. Dietary intake was evaluated using a brief‐type self‐administered diet history questionnaire, from which Total, Plant, and Animal low‐carbohydrate diet scores were calculated. The primary composite outcome was the first occurrence of ischemic heart disease, cerebrovascular disease, peripheral artery disease, or all‐cause mortality. Associations were analyzed using Cox proportional hazards models. Results Mean age was 51.4 ± 15.1 years, mean HbA1c was 7.9 ± 1.1%, and carbohydrate accounted for 49.3% of energy intake. During follow‐up, 35 participants experienced the primary composite outcome. In multivariable Cox models, the Total LCDS (HR, 0.90; 95% CI: 0.82–0.98; P = 0.012), Plant LCDS (HR, 0.85; 95% CI: 0.76–0.94; P = 0.003), and Animal LCDS (HR, 0.93; 95% CI: 0.87–0.996; P = 0.037) were inversely associated with the outcome. Conclusions Among adults with type 1 diabetes living in Japan, low‐carbohydrate dietary patterns, particularly the Plant low‐carbohydrate diet score, were inversely associated with macrovascular events or all‐cause mortality.