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Topical Area: Dietary Patterns

Dietary Patterns (Poster Session)

(P14-051-23) Changes in Low-Carbohydrate Diet Scores and Weight Change: Results From 3 Prospective Cohort Studies

Sunday, July 23, 2023
12:45 PM – 1:45 PM ET
Location: Poster Board 51

    Presenting Author(s)

  • Binkai Liu, MS (she/her/hers)

    Research Assistant
    Harvard University
    Cambridge, Massachusetts, United States

    • Co-Author(s)

  • Frank B. Hu, MD, PhD

    Professor and Chair
    Harvard T.H. Chan School of Public Health
    Boston, Massachusetts, United States

  • YH

    Yang Hu, ScD

    Research associate
    Harvard T.H. Chan School of Public Health

  • David S. Ludwig, MD, PhD

    Professor of Pediatrics, Harvard Medical School
    Boston Children’s Hospital
    Boston, Massachusetts, United States

  • SR

    Sharan K. Rai

    Harvard T.H. Chan School of Public Health

  • QS

    Qi Sun, PhD

    Associate Professor
    Harvard T.H. Chan School of Public Health
    Boston, Massachusetts, United States

  • MW

    Molin Wang, PhD

    Harvard T.H. Chan School of Public Health
    Boston, Massachusetts, United States

Disclosure(s):
Binkai Liu, MS: No relevant financial relationship(s) with ineligible companies to disclose.


Objectives: To prospectively examine the associations between changes in multiple low-carbohydrate diet (LCD) indices and weight change in US men and women.

Methods: This analysis included 122,701 participants in the Nurses’ Health Study (NHS), NHSII, and the Health Professionals Follow-up Study (HPFS). Biennially assessed self-reported body weight was used to calculate 4-y changes in weight. Diet was assessed every 4-y using a validated food frequency questionnaire. Five versions of graded LCD were defined: 1) a total LCD (TLCD) emphasizing overall lower carbohydrate intake; 2) an animal-based LCD (ALCD) that emphasized animal sources of protein/fat; 3) a vegetable-based LCD (VLCD) that emphasized plant sources of protein/fat; 4) a healthy LCD (HLCD) with less unhealthful carbohydrates, more plant protein and healthy fat; and 5) an unhealthy LCD (ULCD) with less healthful carbohydrates, more animal protein and unhealthy fat. Multivariable generalized linear regression models were used to examine associations between 4-y changes in each of these indices and concomitant 4-y weight changes over 20 years of follow-up.

Results: On average, participants gained 0.5kg (HPFS) to 1.8kg (NHSII) over 4-y intervals. After adjusting for demographics and baseline/concomitant changes of selected lifestyle factors, a 1-SD increase in TLCD score was associated with 0.06kg (95% CI: 0.05, 0.08) more weight gain in our cohorts. Similarly, each 1-SD increase of ALCD score was associated with 0.13kg (0.11, 0.15) more weight gain. In contrast, each 1-SD increase in VLCD score was associated with 0.03kg (0.01, 0.05) less weight gain. Finally, the ULCD and HLCD demonstrated diverging associations: a 1-SD increase of HLCD and ULCD scores was associated with weight changes of -0.37kg (-0.39, -0.35) and 0.39kg (0.37, 0.41), respectively. 

Conclusions: These data suggest that consuming an overall lower carbohydrate dietary pattern is associated with faster weight gain over time. Conversely, LCDs emphasizing high-quality protein, fat, and carbohydrates from whole grains and other plant-based foods are associated with slower weight gain.

Funding Sources: NIH grants UM1 CA186107, P01 CA87969, R01 HL034594, U01 CA167552, R01 HL035464, R01 HL60712, R01 DK120870, R01 DK126698, R01 DK119268, U2C DK129670, DK119268, R01 ES022981, R21 AG070375, and ES022981.