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Background The evidence is inconsistent regarding associations between relative proportions of macronutrient intake and disease risk, potentially due to limitation in accounting for differential effects of simple sugars and dietary fibre, typically grouped as “carbohydrates.” Methods We performed an analysis comprising subjects enrolled in the National Health and Nutrition Examination Survey between 1999 and 2004 to examine the association between the ratio of dietary fibre to carbohydrate intake (FC-R) measure and mortality risk. Subjects were followed through 2011. We categorized subjects based on tertile cutpoints of FC-R, and compared their nutrient intake. We performed Cox proportional hazards regression to estimate hazard ratios (HR) with 95% confidence intervals (95% CI), adjusting for demographic, health history, and lifestyle and dietary factors. Results Among the 6,761 participants (48% males; mean age 57.0 years), 1339 deaths were observed during follow-up. The high FC-R group had the lowest caloric and carbohydrate intake, but the highest protein intake. Increasing values of FC-R was significantly associated with reduced mortality risk (HR 0.95, 95% CI 0.93, 0.97), while percent calories from carbohydrate showed no association. Compared to the low FC-R group, higher FC-R groups showed a trend towards a reduction in mortality risk after adjusting for potential confounders (high group: HR 0.66, 95% CI 0.57, 0.78). Conclusions Our findings support the protective effect of fibre in reducing mortality risk. Mechanisms of the association between FC-R and mortality warrant further investigation. Key messages Individuals with higher FC-R diets had lower mortality risk in a large population study.

1470Relationship between dietary fibre to carbohydrate ratio and mortality risk in the NHANES