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Influence of dietary fat and carbohydrates proportions on plasma lipids, glucose control and low-grade inflammation in patients with type 2 diabetes—The TOSCA.IT Study

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Abstract

Purpose

The optimal macronutrient composition of the diet for the management of type 2 diabetes is debated, particularly with regard to the ideal proportion of fat and carbohydrates. The aim of the study was to explore the association of different proportions of fat and carbohydrates of the diet—within the ranges recommended by different guidelines—with metabolic risk factors.

Methods

We studied 1785 people with type 2 diabetes, aged 50–75, enrolled in the TOSCA.IT Study. Dietary habits were assessed using a validated food-frequency questionnaire (EPIC). Anthropometry, fasting lipids, HbA1c and C-reactive protein (CRP) were measured.

Results

Increasing fat intake from <25 to ≥35 % is associated with a significant increase in LDL-cholesterol, triglycerides, HbA1c and CRP (p < 0.05). Increasing carbohydrates intake from <45 to ≥60 % is associated with significantly lower triglycerides, HbA1c and CRP (p < 0.05). A fiber intake ≥15 g/1000 kcal is associated with a better plasma lipids profile and lower HbA1c and CRP than lower fiber consumption. A consumption of added sugars of ≥10 % of the energy intake is associated with a more adverse plasma lipids profile and higher CRP than lower intake.

Conclusions

In people with type 2 diabetes, variations in the proportion of fat and carbohydrates of the diet, within the relatively narrow ranges recommended by different nutritional guidelines, significantly impact on the metabolic profile and markers of low-grade inflammation. The data support the potential for reducing the intake of fat and added sugars, preferring complex, slowly absorbable, carbohydrates.

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Author information

Authors and Affiliations

  1. Department of Clinical Medicine and Surgery, University “Federico II” of Naples, Naples, Italy

    M. Vitale, M. Masulli, A. A. Rivellese, O. Ciano, G. Clemente, C. Iovine, G. Romano, R. Schiano di Cola, A. A. Turco, G. Riccardi & O. Vaccaro

  2. Diabetology, Infermi Hospital, Rimini, Italy

    A. C. Babini

  3. UOC Malattie Metaboliche e Diabetologia, INRCA-IRCCS Institute, Ancona, Italy

    M. Boemi

  4. Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy

    E. Bonora & M. Cigolini

  5. UOC di Diabetologia Universitaria, Ospedale Santa Maria Goretti, Latina, Italy

    R. Buzzetti

  6. Division of Endocrinology and Metabolism, University of Foggia, Foggia, Italy

    M. Cignarelli

  7. UO Endocrinologia e Diabetologia, ASP, Potenza, Italy

    G. Citro

  8. SSD Diabetologia e Malattie del Metabolismo, ASL 4 Chiavarese, Genova, Italy

    L. Corsi

  9. Clinical and Experimental Medicine, University of Parma, Parma, Italy

    E. Dall’Aglio

  10. Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

    S. Del Prato

  11. UOC Diabetologia, ASL 6, Livorno, Italy

    G. Di Cianni

  12. UO Diabetologia, USL 1, Massa e Carrara, Italy

    M. A. Dolci

  13. Endocrinology and Metabolic Diseases, University of Palermo, Palermo, Italy

    C. Giordano

  14. UO Diabetologia, Ospedale San Salvatore, L’Aquila, Italy

    R. Iannarelli

  15. Department of Medicine, University of Padova, Padova, Italy

    A. Lapolla

  16. Department of Internal Medicine, Tor Vergata University, Rome, Italy

    D. Lauro

  17. Unit of Diabetology, Sandro Pertini Hospital, Rome, Italy

    S. Leotta

  18. Department of Internal Medicine, University of Genova, IRCCS San Martino, Genova, Italy

    C. Mazzucchelli

  19. UOSD, Presidio Ospedaliero di Atri, Atri, Italy

    V. Montani

  20. MISEM, University of Perugia, Perugia, Italy

    G. Perriello

  21. Diabetologia, ASL Torino 5, Torino, Italy

    F. Romeo

  22. Presidio Ospedaliero di Lanciano, Lanciano, Italy

    L. Santarelli

  23. Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy

    S. Squatrito

  24. SOC di Endocrinologia e Malattie del Metabolismo, AOU “S. Maria della Misericordia”, Udine, Italy

    L. Tonutti

  25. Endocrinology and Diabetes Unit, AO Papa Giovanni XXIII, Bergamo, Italy

    R. Trevisan

  26. Unità Operativa di Malattie Metaboliche, Dietologia e Nutrizione Clinica, AOU Arcispedale “S. Anna”, Ferrara, Italy

    C. Zamboni

Authors
  1. M. Vitale
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  2. M. Masulli
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  3. A. A. Rivellese
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  4. A. C. Babini
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  5. M. Boemi
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  6. E. Bonora
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  7. R. Buzzetti
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  8. O. Ciano
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  9. M. Cignarelli
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  10. M. Cigolini
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  11. G. Clemente
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  12. G. Citro
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  13. L. Corsi
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  14. E. Dall’Aglio
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  15. S. Del Prato
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  16. G. Di Cianni
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  17. M. A. Dolci
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  18. C. Giordano
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  19. R. Iannarelli
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  20. C. Iovine
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  21. A. Lapolla
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  22. D. Lauro
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  23. S. Leotta
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  24. C. Mazzucchelli
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  25. V. Montani
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  26. G. Perriello
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  27. G. Romano
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  28. F. Romeo
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  29. L. Santarelli
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  30. R. Schiano di Cola
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  31. S. Squatrito
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  32. L. Tonutti
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  33. R. Trevisan
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  34. A. A. Turco
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  35. C. Zamboni
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  36. G. Riccardi
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  37. O. Vaccaro
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Corresponding author

Correspondence to O. Vaccaro.

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Conflict of interest

The authors declare that they have no conflict of interest.

Funding

The study is supported by the Italian Medicines Agency (AIFA) within the Independent Drug Research Program contract n°. FARM6T9CET and by Diabete Ricerca, the no profit Research Foundation of the Italian Diabetes Society.

Additional information

On behalf of the TOSCA.IT Study Group.

The complete list of Investigators and participating centers is available in the online appendix.

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Vitale, M., Masulli, M., Rivellese, A.A. et al. Influence of dietary fat and carbohydrates proportions on plasma lipids, glucose control and low-grade inflammation in patients with type 2 diabetes—The TOSCA.IT Study. Eur J Nutr 55, 1645–1651 (2016). https://doi.org/10.1007/s00394-015-0983-1

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  • DOI: https://doi.org/10.1007/s00394-015-0983-1

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