Evidence map›Paper›PMID 28864332›Full record

ArticleLancet (London, England)2017

Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study.

Mahshid Dehghan, Andrew Mente, Xiaohe Zhang, Sumathi Swaminathan, Wei Li, Viswanathan Mohan, Romaina Iqbal, Rajesh Kumar, Edelweiss Wentzel-Viljoen, Annika Rosengren and 28 more

Registry-linked trialAbstract readComparative StudyMulticenter Study
PubMed Publisher
In one paragraph

Article in Lancet (London, England), 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05275608 (Effects of Very Low Calorie Ketogenic Diet on Microbiota, Adipose Tissue and Immunitary Regulation), which is not on this map. Cited by 493 papers, 15 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
493citing papers in PubMed, 15 pooled it
133.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05275608 narecruitingnot on this mapstarted 2022, after this paper: background citation

Effects of Very Low Calorie Ketogenic Diet on Microbiota, Adipose Tissue and Immunitary Regulation: Pilot Study on Patients with Metabolic Syndrome

TypeinterventionalSponsorAzienda Ospedaliero Universitaria Maggiore della CaritaRan2022 to 2025Enrolled40ConditionsDiabetes Mellitus, Type 2, Non-alcoholic Fatty Liver Disease, Obesity, Metabolic SyndromeArmsVLCKD diet with replacing meals, Hypocaloric mediterranean Diet
3 · Its place in the literature

Who cites it

493 citing papers in PubMed, 15 syntheses or guidelines pooled it, 1,095 citations in OpenAlex.

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433 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

38 authors at 20 institutions in 18 countries.

Mahshid DehghanPopulation Health Research Institute, McMaster University, Hamilton, ON, Canada. Electronic address: mahshid.dehghan@phri.ca.
Andrew MentePopulation Health Research Institute, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Xiaohe ZhangPopulation Health Research Institute, McMaster University, Hamilton, ON, Canada.
Sumathi SwaminathanSt John's Research Institute, St John's National Academy of Health Sciences, Sarjapur Road, Koramangala, Bangalore, Karnataka, India.
Wei LiState Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
Viswanathan MohanMadras Diabetes Research Foundation, Chennai, India.
Romaina IqbalDepartments of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan.
Rajesh KumarPGIMER School of Public Health, Chandigarh, India.
Edelweiss Wentzel-ViljoenCentre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
Annika RosengrenDepartment of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
Leela Itty AmmaHealth Action by People TC 1/1706, Medical College PO, Trivandrum, India.
Alvaro AvezumDante Pazzanese Institute of Cardiology, Sao Paulo, Brazil.
Jephat ChifambaUniversity of Zimbabwe, College of Health Sciences, Department of Physiology, Harare, Zimbabwe.
Rafael DiazEstudios Clínicos Latinoamérica, ECLA, Rosario, Argentina.
Rasha KhatibInstitute of Community and Public Health, Birzeit University, Birzeit, occupied Palestinian territory.
Scott LearFaculty of Health Sciences, Department of Biomedical Physiology & Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
Patricio Lopez-JaramilloFundacion Oftalmologica de Santander-FOSCAL, Floridablanca-Santander, Colombia.
Xiaoyun LiuState Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
Rajeev GuptaEternal Heart Care Centre and Research Institute, Jaipur, India.
Noushin MohammadifardIsfahan Cardiovascular Research Centre, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Nan GaoState Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
Aytekin OguzIstanbul Medeniyet University, Faculty of Medicine, Department of Internal Medicine, Goztepe, Istanbul, Turkey.
Anis Safura RamliFaculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia.
Pamela SeronUniversidad de La Frontera, Temuco, Araucanía, Chile.
Yi SunState Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
Andrzej SzubaDivision of Angiology, Wroclaw Medical University, Wroclaw, Poland.
Lungiswa TsolekileUniversity of the Western Cape, Bellville, Western Province, Cape Town, South Africa.
Andreas WielgoszUniversity of Ottawa Department of Medicine, Ottawa, ON, Canada.
Rita YusufIndependent University, Bangladesh, Dhaka, Bangladesh.
Afzal Hussein YusufaliDubai Medical University, Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates.
Koon K TeoPopulation Health Research Institute, McMaster University, Hamilton, ON, Canada.
Sumathy RangarajanPopulation Health Research Institute, McMaster University, Hamilton, ON, Canada.
Gilles DagenaisUniversité Laval, Institut Universitaire de Cardiologie, Ville de Québec, QC, Canada.
Shrikant I BangdiwalaPopulation Health Research Institute, McMaster University, Hamilton, ON, Canada.
Shofiqul IslamPopulation Health Research Institute, McMaster University, Hamilton, ON, Canada.
Sonia S AnandDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Salim YusufPopulation Health Research Institute, McMaster University, Hamilton, ON, Canada.
Prospective Urban Rural Epidemiology (PURE) study investigators
Population Health Research Institute · CAChinese Academy of Medical Sciences & Peking Union Medical College · CNBirzeit University · PSDubai Health Authority · AEAga Khan University · PKMadras Diabetes Research Foundation · INMcMaster University · CANorth-West University · ZAPost Graduate Institute of Medical Education and Research · INUniversity of Gothenburg · SEUniversity of Ottawa · CAUniversity of the Western Cape · ZAFoscal Hospital · COInstitut universitaire de cardiologie et de pneumologie de Québec · CAIsfahan University of Medical Sciences · IRIstanbul Medeniyet University · TRSimon Fraser University · CAUniversiti Teknologi MARA · MYUniversity of Zimbabwe · ZWWroclaw Medical University · PL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe relationship between macronutrients and cardiovascular disease and mortality is controversial. Most available data are from European and North American populations where nutrition excess is more likely, so their applicability to other populations is unclear.

methodsThe Prospective Urban Rural Epidemiology (PURE) study is a large, epidemiological cohort study of individuals aged 35-70 years (enrolled between Jan 1, 2003, and March 31, 2013) in 18 countries with a median follow-up of 7·4 years (IQR 5·3-9·3). Dietary intake of 135 335 individuals was recorded using validated food frequency questionnaires. The primary outcomes were total mortality and major cardiovascular events (fatal cardiovascular disease, non-fatal myocardial infarction, stroke, and heart failure). Secondary outcomes were all myocardial infarctions, stroke, cardiovascular disease mortality, and non-cardiovascular disease mortality. Participants were categorised into quintiles of nutrient intake (carbohydrate, fats, and protein) based on percentage of energy provided by nutrients. We assessed the associations between consumption of carbohydrate, total fat, and each type of fat with cardiovascular disease and total mortality. We calculated hazard ratios (HRs) using a multivariable Cox frailty model with random intercepts to account for centre clustering.

findingsDuring follow-up, we documented 5796 deaths and 4784 major cardiovascular disease events. Higher carbohydrate intake was associated with an increased risk of total mortality (highest [quintile 5] vs lowest quintile [quintile 1] category, HR 1·28 [95% CI 1·12-1·46], p

interpretationHigh carbohydrate intake was associated with higher risk of total mortality, whereas total fat and individual types of fat were related to lower total mortality. Total fat and types of fat were not associated with cardiovascular disease, myocardial infarction, or cardiovascular disease mortality, whereas saturated fat had an inverse association with stroke. Global dietary guidelines should be reconsidered in light of these findings.

fundingFull funding sources listed at the end of the paper (see Acknowledgments).

Indexed as

Cause of DeathAdultAgedCardiovascular DiseasesCohort StudiesDeveloped CountriesDeveloping CountriesDietDietary CarbohydratesDietary FatsEnergy MetabolismFemaleHumansIncomeInternationalityMaleDietary CarbohydratesDietary Fats

Identifiers

PMID28864332
OpenAlexW2751423033

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.