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Comment & Response
November 16, 2020

The Assessment of Different Diets and Mortality Fails to Address Unmeasured Confounding—Reply

Author Affiliations
  • 1Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
  • 2Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
  • 3Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
  • 4Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, New York
JAMA Intern Med. 2021;181(1):138-139. doi:10.1001/jamainternmed.2020.1388

In Reply We appreciate the thoughtful comments from Gong and colleagues on our study.1 In our study, we fully acknowledged the limitations of our analysis and urged caution in the interpretation of our results in the context of other studies. To minimize residual confounding of smoking and alcohol use, we carefully adjusted for smoking status (never smoker, former smoker, current smoker: 1-14, 15-24, or ≥25 cigarettes/d) and alcohol consumption (0, 0.1-5, 5-15, 15-30, ≥30 g/d). Our results showed that the associations of low-carbohydrate and low-fat diet scores and mortality are independent of tobacco and alcohol use. Our stratified analyses were based on broader categories of smoking status (never smoker vs ever smoker) and alcohol consumption (never drinker vs ever drinker) and consistent results were observed across these categories. When we further adjusted for detailed information on smoking status (cigarettes/d) and alcohol consumption (grams/d) among smokers and drinkers, respectively, the results remained similar, supporting the robustness of our findings.

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