BACKGROUND: Low-carbohydrate weight-loss diets remain popular; however, the long-term effects of these diets are not known. OBJECTIVE: The objective was to examine the association between low-carbohydrate-diet score and risk of type 2 diabetes DESIGN: We prospectively examined the association between low-carbohydrate-diet score (based on percentage of energy as carbohydrate, fat, and protein) and risk of diabetes among 85 059 women in the Nurses' Health Study. RESULTS: During 20 y of follow-up, we documented 4670 cases of type 2 diabetes. The multivariate relative risk (RR) of diabetes, after adjustment for body mass index and other covariates, in a comparison of the highest decile of low-carbohydrate-diet score with the lowest was 0.90 (95 CI: 0.78, 1.04; P for trend = 0.26). The multivariate RR for the comparison of extreme deciles of low-carbohydrate-diet score based on total carbohydrate, animal protein, and animal fat was 0.99 (95 CI: 0.85, 1.16; P for trend = 1.0), whereas the RR for a low-carbohydrate-diet score based on total carbohydrate, vegetable protein, and vegetable fat was 0.82 (95 CI: 0.71, 0.94; P for trend = 0.001). A higher dietary glycemic load was strongly associated with an increased risk of diabetes in a comparison of extreme deciles (RR: 2.47; 95 CI: 1.75, 3.47; P for trend < 0.0001)). A higher carbohydrate consumption was also associated with an increased risk of diabetes in a comparison of extreme deciles (RR: 1.26; 95 CI: 1.07, 1.49; P for trend = 0.003). CONCLUSION: These data suggest that diets lower in carbohydrate and higher in fat and protein do not increase the risk of type 2 diabetes in women. In fact, diets rich in vegetable sources of fat and protein may modestly reduce the risk of diabetes.
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