Associations between dietary macronutrient composition and cardiometabolic health: data from NHANES 1999-2014

Abstract

Purpose: Dietary macronutrients significantly impact cardiometabolic health, yet research often focuses on individual macronutrient relationships. This study aimed to explore the associations between dietary macronutrient composition and cardiometabolic health.

Methods: This study included 33,681 US adults (49.7 ± 18.3 years; 52.5% female) from the National Health and Nutrition Examination Survey during 1999-2014. Dietary data was derived from 1 to 2 separate 24-hour recalls and cardiometabolic health included lipid profile, glycemic control, blood pressure, and adiposity collected in a mobile examination center. Associations between dietary macronutrient composition and cardiometabolic health were examined using generalized additive models adjusted for age, socio-demographics, lifestyle, and diet quality.

Results: In females, triglycerides (P < 0.01) and HDL cholesterol (P < 0.01) were the least optimal in diets containing lower fat (10%) and higher carbohydrate (75%). In males, HDL cholesterol was positively associated with fat (P < 0.01) and no association with triglycerides was detected. Total-C associations were male specific (P = 0.01) and highest in diets composed of 25% protein, 30% carbohydrate, and 45% fat. In both sexes, systolic blood pressure (P ≤ 0.02) was highest in diets containing lower fat (10%) coupled with moderate protein (25%). Diastolic blood pressure associations were female specific (P < 0.01) with higher values in those consuming the upper range of fat (55%). There were no associations of macronutrient composition with glycemic control or adiposity.

Conclusion: This study revealed sex-specific relationships between macronutrient composition and cardiometabolic health. Future research is needed to explore these relationships across age groups.

Keywords: Cardiometabolic health; Cardiovascular disease; Diet; Macronutrients; NHANES.

Fig. 1

Dietary macronutrient composition and cardiometabolic health markers for females. The mixture triangles show the model predictions of the cardiometabolic health markers with a significant association with macronutrient composition. Predictions were made at mean caloric intake of females (1811 kcal/day) across the sex-specific range of macronutrient percentages in this dataset. Percentage of fat can be inferred as decreasing moving away from the origin, such that each point on the triangle can be summed to equal 100%. Response values are colored such that warm colors display higher values and cooler colors display lower values. Response surfaces were adjusted for age, household income, race/ethnicity, education level, smoking, alcohol, physical activity, BMI, and the Healthy Eating Index

Fig. 2

Dietary macronutrient composition and cardiometabolic health markers for males. The mixture triangles show the model predictions of the cardiometabolic health markers with a significant association with macronutrient composition. Predictions were made at mean caloric intake of males (1890 kcal/day) across the sex-specific range of macronutrient percentages in this dataset. The x and y-axis show protein and carbohydrate respectively. Percentage of fat can be inferred as decreasing moving away from the origin, such that each point on the triangle can be summed to equal 100%. Response values are colored such that warm colors display higher values and cooler colors display lower values. Response surfaces were adjusted for age, household income, race/ethnicity, education level, smoking, alcohol, physical activity, BMI, and the Healthy Eating Index