Comparison of the ketogenic ratio of macronutrients with the low-carbohydrate diet score and their association with risk of type 2 diabetes in postmenopausal women: A secondary analysis of the women's health initiative

Tyler J Titcomb; Buyun Liu; Terry L Wahls; Linda G Snetselaar; Aladdin H Shadyab; Fred K Tabung; Nazmus Saquib; Chrisa Arcan; Lesley F Tinker; Robert B Wallace; Wei Bao

doi:10.1016/j.jand.2022.12.004

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Comparison of the ketogenic ratio of macronutrients with the low-carbohydrate diet score and their association with risk of type 2 diabetes in postmenopausal women: A secondary analysis of the women's health initiative

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Comparison of the ketogenic ratio of macronutrients with the low-carbohydrate diet score and their association with risk of type 2 diabetes in postmenopausal women: A secondary analysis of the women's health initiative

Tyler J Titcomb, Buyun Liu, Terry L Wahls, Linda G Snetselaar, Aladdin H Shadyab, Fred K Tabung, Nazmus Saquib, Chrisa Arcan, Lesley F Tinker, Robert B Wallace, …

Journal of the Academy of Nutrition and Dietetics, Vol.123(8), pp.1152-1161.e4

08/2023

DOI: 10.1016/j.jand.2022.12.004

PMCID: PMC10279805

PMID: 36549565

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Abstract

Previous attempts to identify low-carbohydrate diets (LCDs) in epidemiological studies relied on the LCD score, which is unable to identify ketogenic dieters. Ketogenic ratios of macronutrients are clinical equations proposed to predict ketogenic diets; however, their utility in epidemiological studies is unknown. To determine the number of participants consuming a ketogenic diet, compare ketogenic ratios to the LCD score, and evaluate their association with type 2 diabetes mellitus (T2DM). Secondary analysis of the Women's Health Initiative (WHI) with 17.9 ± 6.03 years of follow-up. Baseline food frequency questionnaires were used to calculate the ketogenic ratio as follows: (0.9*grams fat + 0.46*grams protein) divided by (0.1*grams fat + 0.58*grams protein + grams net carbohydrate), a value ≥1.5 is the minimum threshold for a ketogenic diet. 125,982 postmenopausal women without diabetes (age 50-79 years) enrolled in the multicenter WHI observational study and clinical trials were included. Risk of self-reported incident T2DM. Cox proportional hazards models, adjusted for age, race, ethnicity, education, income, health insurance, relationship status, geographic region, WHI study component, female hormone use, smoking status, alcohol use, recreational physical activity, total energy intake, diet quality, body mass index, hyperlipidemia, and hypertension, were used to compare hazard ratios (HRs) and 95% confidence intervals (CIs) for T2DM between quintiles of the ketogenic ratio. 18,775 incident cases of T2DM occurred. The median ketogenic ratio was 0.35 (interquartile range 0.28-0.42) and 15 individuals (0.01%) exceeded the threshold for a ketogenic diet. Higher ketogenic ratio quintiles were associated with increased risk of T2DM in a dose-dependent manner. Comparing extreme quintiles of the ketogenic ratio, the HR and 95% CI for diabetes was 1.24 (1.18-1.31; P < 0.001) in fully adjusted models. Similarly, comparing extreme quintiles, the HR (95% CI) for diabetes was 1.36 (1.29-1.43; P < 0.001) for the LCD score and 1.13 (1.07-1.19; P < 0.001) for the simplified ketogenic ratio in fully adjusted models. Increasing ketogenic ratio values are associated with increased risk of T2DM and align well with LCD scores; however, too few participants consumed a ketogenic diet to determine its association with T2DM.

Diabetes

low-carbohydrate diet score

ketogenic ratio

postmenopausal women

ketogenic diet

nutritional epidemiology

Details

Title: Subtitle: Comparison of the ketogenic ratio of macronutrients with the low-carbohydrate diet score and their association with risk of type 2 diabetes in postmenopausal women: A secondary analysis of the women's health initiative
Creators: Tyler J Titcomb
Buyun Liu
Terry L Wahls - Clinical Professor, Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA. Electronic address: Terry-wahls@uiowa.edu
Linda G Snetselaar - Professor, Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA. Electronic address: Linda-snetselaar@uiowa.edu
Aladdin H Shadyab - University of California San Diego
Fred K Tabung - The Ohio State University
Nazmus Saquib - Associate Professor, Department of Research, Sulaiman AlRajhi University, Al Bukayriah, Saudi Arabia. Electronic address: a.saquib@sr.edu.sa
Chrisa Arcan - Virginia Commonwealth University
Lesley F Tinker - Fred Hutch Cancer Center
Robert B Wallace
Wei Bao
Resource Type: Journal article
Publication Details: Journal of the Academy of Nutrition and Dietetics, Vol.123(8), pp.1152-1161.e4
DOI: 10.1016/j.jand.2022.12.004
PMID: 36549565
PMCID: PMC10279805
NLM abbreviation: J Acad Nutr Diet
ISSN: 2212-2672
eISSN: 2212-2680
Language: English
Electronic publication date: 12/19/2022
Date published: 08/2023
Academic Unit: Neurology; Epidemiology; Fraternal Order of Eagles Diabetes Research Center; Injury Prevention Research Center; General Internal Medicine; Internal Medicine
Record Identifier: 9984353495502771

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