Clinical Edge

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Fats, Carbohydrate Intake & CVD/Mortality Risk

Lancet; 2017 Nov 4; Dehghan, Mente, et al

Among individuals from 18 countries, high carbohydrate intake was associated with higher risk of total mortality; however, total fat and individual types of fat were related to lower total mortality. The prospective cohort study also showed that total fat and types of fat were not associated with cardiovascular disease (CVD), myocardial infarction (MI), or CVD mortality, whereas saturated fat had an inverse association with stroke. The Prospective Urban Rural Epidemiology (PURE) study included 135,335 individuals aged 35 to 70 years between January 1, 2003, and March 31, 2013 in 18 countries with a median follow-up of 7.4 years. Researchers found:

  • There were 5,796 deaths and 4,784 major CVD events during follow-up.
  • Higher carbohydrate intake was associated with an increased risk of total mortality but not with the risk of CVD or CVD mortality.
  • Intake of total fat and each type of fat was associated with lower risk of total mortality.
  • Higher saturated fat intake was associated with lower risk of stroke.
  • Total fat and saturated and unsaturated fats were not significantly associated with risk of MI or CVD mortality.

Dehghan M, Mente A, Zhang X, et al. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from 5 continents (PURE): a prospective cohort study. Lancet. 2017;390:2050-2062. doi:10.1016/S0140-6736(17)32252-3.


This study supports recent research that the traditional approach to a healthy diet, promulgated over the last 20 years, which recommended decreasing the proportion of fat in the diet, which in turn increases the amount of carbohydrate in the diet, was incorrect. A theory that has gained traction over the last 10 years is that diets with a large amount of simple carbohydrate cause a rapid insulin response, which in turn drives glucose into fat cells, leading to a rapid drop in blood sugar and, thus, an increase in hunger. This leaves the body with long periods of low blood sugar and a sense of hunger, essentially starving in the mist of plenty. The current study of more than 150,000 individuals suggests that low fat/high carb may be associated with lower age-specific mortality, and is a healthier choice than traditional low-fat diets. —Neil Skolnik, MD

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