![]() Permission was obtained in March 2020 from the Korea Centers for Disease Control and Prevention for the data linking the causes of death from Statistics Korea with the KHANES data. ![]() Detailed information on KNHANES is available at. KNHANES is an ongoing surveillance system in the Republic of Korea that assesses the health and nutritional status of Koreans, monitors trends in health risk factors, and provides data for the development and evaluation of health policies in Korea. Population data came from the Korea National Health and Nutrition Examination Survey (KNHANES) linked with causes of death data (version 1.1) from Statistics Korea. Results from the study were aimed to propose an appropriate macronutrient intake ratio to reduce all-cause mortality. Therefore, we investigated the association between carbohydrate, fat, and protein intake with all-cause mortality using a large representative Korean dataset. However, studies assessing macronutrient intake and all-cause mortality in Asians remain lacking. Changes in eating patterns affect the occurrences of lifestyle-related diseases, such as obesity, metabolic syndrome, and cardiovascular diseases. In South Korea, carbohydrate intake decreased and fat intake increased, while protein intake remained constant during rapid economic growth. Asians experienced rapid economic and nutrition transition. ĭietary habits differ across countries, races, and cultures. A large prospective cohort study conducted in the US reported higher mortality with high saturated fatty acids, trans-fatty acids, animal monounsaturated fatty acids, α-linolenic acid, and arachidonic acid intake. The Atherosclerosis Risk in Communities (ARIC) study showed a U-shaped association between carbohydrate intake and mortality. The Prospective Urban Rural Epidemiology (PURE) study reported that high carbohydrate intake was associated with higher total mortality risk, whereas total fat intake was related to lower total mortality risk. ĭata associating macronutrient intake proportion and all-cause mortality remain conflicting. The 2015–2020 Dietary Guideline for Americans recommends that carbohydrates comprise 45–65% of calories, fat 25–35% of calories, and protein 10–30% of calories. The Institute of Medicine has developed a new approach for establishing recommended dietary allowances for macronutrients. Nutritional dietary guidelines recommend the ideal energy and macronutrient intake to improve public health and prevent chronic diseases. Recent works have suggested that macronutrient composition and balance, rather than total energy intake, contribute to expanded lifespan. ![]() Hormesis in aging refers to beneficial effects resulting from the cellular responses to mild and repeated stress. Calorie restriction retards the aging processes through hormetic action by acting as low-intensity stress. Increasing evidence has shown that calorie restriction without malnutrition increases lifespan by reducing the metabolic rate and improving insulin resistance, oxidative stress, and inflammation. Many studies have reported that specific dietary interventions can affect health-related outcomes and lifespan. Macronutrients (carbohydrate, fat, and protein) supply energy and influence various physiological functions. ![]() Our findings suggest current Korean dietary guidelines should be revised to prolong life expectancy. We found a U-shaped association between all-cause mortality and carbohydrate intake as well as fat intake, with minimal risk observed at 50–60% carbohydrate and 30–40% fat intake. There was no significant association between protein intake proportion and all-cause mortality. Time to exceed 1% of the all-cause mortality rate was longest in participants with 50–60% carbohydrate, 30–40% fat, and 20–30% protein intake. We documented 2110 deaths during the follow-up period. Hazard ratios (HRs) were calculated using the multivariable Cox proportional regression model after adjusting for confounders. This cohort study investigated 42,192 participants from the Korea National Health and Nutrition Examination Survey (KNHANES) linked with causes of death data (2007–2015). We aim to investigate the association between carbohydrate, fat, and protein intake and all-cause mortality in Koreans. Determining the ideal ratio of macronutrients for increasing life expectancy remains a high priority in nutrition research.
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