Conference PaperPDF Available
Arrhythmias and Clinical EP
4
JACC March 12, 2019
Volume 73, Issue 9
U-SHAPED RELATIONSHIP BETWEEN CARBOHYDRATE INTAKE PROPORTION AND INCIDENT
ATRIAL FIBRILLATION
Poster Contributions
Poster Hall, Hall F
Saturday, March 16, 2019, 10:00 a.m.-10:45 a.m.
Session Title: Arrhythmias and Clinical EP: Other 1
Abstract Category: 06. Arrhythmias and Clinical EP: Other
Presentation Number: 1123-310
Authors: Xiaodong Zhuang, Shaozhao Zhang, Huimin Zhou, Zhimin Du, Xinxue Liao, Cardiology Department, the First Afliated Hospital of
Sun Yat-Sen University, Guangzhou, People’s Republic of China, Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou,
People’s Republic of China
Background: We aim to assess the association of carbohydrate intake proportion and the risk of atrial fibrillation (AF) incident in
Atherosclerosis Risk in Communities (ARIC) study.
Methods: Participants free of AF were included. AF was ascertained from electrocardiograms, hospital discharge codes and death
certificates. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for
the association between carbohydrate intake proportion and incident AF.
Results: The average age was 54.2±5.8 years, and 45.3% were male for 13,852 participants. The carbohydrate intake proportion was
48.8±9.4%. During a median follow-up of 22.4 years, 1,892 cases of AF occurred. The HR for incident AF comparing the second and third
tertiles of carbohydrate intake proportion to the lowest tertile were 0.82 (95% CI 0.73-0.93) and 0.84 (95% CI 0.71-0.99) respectively.
Spline regression analysis showed a U-shaped relationship between carbohydrate intake and risk of AF incident (P < 0.005), with the
lowest observed risk associated with carbohydrate intake proportion of 39%-61%.
Conclusion: The restriction of carbohydrate intake increases AF incident in individuals with low and moderate carbohydrate intake. We
suggested that low carbohydrate diet as a popular way to lose weight may not be extensively recommended because of the increased risk
of incident AF.
... Recently, Zhuang et al. 106 examined the association between CHO intake and the risk of atrial fibrillation (AF) in Atherosclerosis Risk in Communities (ARIC) study participants (n 5 13,852) who did not have AF. They found a Ushaped curve between CHO intake and AF with the lowest observed risk associated with a CHO intake of 39-61% TDE and cautioned against the use of low-CHO diets for weight loss due to the increased risk of AF. 106 Individuals with chronic illnesses may be more susceptible to adverse effects due to the extreme dietary changes that are inherent with low-CHO diets and very-low-CHO/ KDs. ...
... Recently, Zhuang et al. 106 examined the association between CHO intake and the risk of atrial fibrillation (AF) in Atherosclerosis Risk in Communities (ARIC) study participants (n 5 13,852) who did not have AF. They found a Ushaped curve between CHO intake and AF with the lowest observed risk associated with a CHO intake of 39-61% TDE and cautioned against the use of low-CHO diets for weight loss due to the increased risk of AF. 106 Individuals with chronic illnesses may be more susceptible to adverse effects due to the extreme dietary changes that are inherent with low-CHO diets and very-low-CHO/ KDs. Because the effects of these diets on patients with chronic illnesses is unknown, it is recommended that patients with heart failure, kidney disease, and liver disease who choose to follow a low-CHO or very-low-CHO/KD should do so under close medical supervision and receive medical nutrition therapy appropriate for their specific diagnosis from a registered dietitian nutritionist (RDN). ...
... For individuals with ASCVD, risk of atrial fibrillation, the presence or history of heart failure, kidney disease, or liver disease who choose to follow a low-CHO or very-low-CHO diet, close medical supervision is recommended. 106 More frequent monitoring of vitamin K-dependent anticoagulation therapy may be reasonable with a very-low-CHO/KD due to the potential change in vitamin K intake and its effect on anticoagulation therapy. 45,100 III: Potential Harm C-EO Long-term consumption of extreme CHO intakes (low and high) has been associated with all-cause, CV, and cancer mortality in the general population. ...
Article
Full-text available
Historically, low-carbohydrate (CHO) and very-low-CHO diets have been used for weight loss. Recently, these diets have been promoted for type 2 diabetes (T2D) management. This scientific statement provides a comprehensive review of the current evidence base available from recent systematic reviews and meta-analyses on the effects of low-CHO and very-low-CHO diets on body weight, lipoprotein lipids, glycemic control, and other cardiometabolic risk factors. In addition, evidence on emerging risk factors and potential safety concerns of low-CHO and very-low-CHO diets, especially for high-risk individuals, such as those with genetic lipid disorders, was reviewed. Based on the evidence reviewed, low-CHO and very-low-CHO diets are not superior to other dietary approaches for weight loss. These diets may have advantages related to appetite control, triglyceride reduction, and reduction in the use of medication in T2D management. The evidence reviewed showed mixed effects on low-density lipoprotein cholesterol levels with some studies showing an increase. There was no clear evidence for advantages regarding effects on other cardiometabolic risk markers. Minimal data are available regarding long-term (>2 years) efficacy and safety. Clinicians are encouraged to consider the evidence discussed in this scientific statement when counseling patients on the use of low-CHO and very-low-CHO diets.
... 42 Ketone bodies are associated with increasing membrane excitability and arrhythmogenesis. 36 Low levels of carbohydrate intake were associated with a higher risk of atrial fibrillation; 15% of daily caloric intake from carbohydrates corresponded with an estimated Hazard Ratio = 2. 43 In a small observational study (n = 20) of a pediatric population, 15% developed prolonged QT interval and 15% developed cardiac chamber enlargements after consuming a ketogenic diet. 44 Ketogenesis has demonstrated an increase in various inflammatory markers in both animal and human studies. ...
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Cardiovascular disease remains one of the most prevalent and preventable chronic conditions worldwide. Diet modification is the foundation of cardiovascular disease prevention. Several dietary approaches have emerged to promote better cardiovascular health. The rapid dissemination of anecdotal and observational data through the internet and social media has caused confusion amongst providers and patients. The aim of this comprehensive review is to present objective insights into two of today's most popular fad diets, ketogenic diet and intermittent fasting. We will evaluate the performance of these diets based on their impact on cardiovascular risk factors. •The ketogenic dietary pattern and intermittent fasting are new approaches that have been touted as diets that have a potential to reduce the risk for cardiovascular disease. •Current evidence indicates that the ketogenic diet results in short-term weight loss and improvements in glucose metabolism. However there remains a concern about its dyslipidemic potential. •Intermittent fasting has more a better impact on the cardiometabolic profile with much less risk for dyslipidemia.
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