Open Access Highly Accessed Open Badges Research

Low-carbohydrate, high-protein diet score and risk of incident cancer; a prospective cohort study

Lena Maria Nilsson1*, Anna Winkvist2, Ingegerd Johansson3, Bernt Lindahl4, Göran Hallmans4, Per Lenner5 and Bethany Van Guelpen6

Author affiliations

1 Department of Public Health and Clinical Medicine,Nutritional Research, Umeå University, Umeå SE-90185, Sweden

2 Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Göteborg SE-40530, Sweden

3 Department of Odontology, Umeå University, Umeå SE-90185, Sweden

4 Department of Public Health and Clinical Medicine, Umeå University, Umeå SE-90185, Sweden

5 Department of Oncology and Radiation Sciences, Oncological Center, Umeå University, Umeå SE-90185, Sweden

6 Department of Medical Biosciences, Pathology, Umeå University, Umeå SE-90185, Sweden

For all author emails, please log on.

Citation and License

Nutrition Journal 2013, 12:58  doi:10.1186/1475-2891-12-58

Published: 7 May 2013



Although carbohydrate reduction of varying degrees is a popular and controversial dietary trend, potential long-term effects for health, and cancer in specific, are largely unknown.


We studied a previously established low-carbohydrate, high-protein (LCHP) score in relation to the incidence of cancer and specific cancer types in a population-based cohort in northern Sweden. Participants were 62,582 men and women with up to 17.8 years of follow-up (median 9.7), including 3,059 prospective cancer cases. Cox regression analyses were performed for a LCHP score based on the sum of energy-adjusted deciles of carbohydrate (descending) and protein (ascending) intake labeled 1 to 10, with higher scores representing a diet lower in carbohydrates and higher in protein. Important potential confounders were accounted for, and the role of metabolic risk profile, macronutrient quality including saturated fat intake, and adequacy of energy intake reporting was explored.


For the lowest to highest LCHP scores, 2 to 20, carbohydrate intakes ranged from median 60.9 to 38.9% of total energy intake. Both protein (primarily animal sources) and particularly fat (both saturated and unsaturated) intakes increased with increasing LCHP scores. LCHP score was not related to cancer risk, except for a non-dose-dependent, positive association for respiratory tract cancer that was statistically significant in men. The multivariate hazard ratio for medium (9–13) versus low (2–8) LCHP scores was 1.84 (95% confidence interval: 1.05-3.23; p-trend = 0.38). Other analyses were largely consistent with the main results, although LCHP score was associated with colorectal cancer risk inversely in women with high saturated fat intakes, and positively in men with higher LCHP scores based on vegetable protein.


These largely null results provide important information concerning the long-term safety of moderate carbohydrate reduction and consequent increases in protein and, in this cohort, especially fat intakes. In order to determine the effects of stricter carbohydrate restriction, further studies encompassing a wider range of macronutrient intakes are warranted.

Diet; Cancer; Macronutrients; Carbohydrate intake; Protein intake; Fat intake; Cohort study