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



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.


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.


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.


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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Corresponding author

Correspondence to O. Vaccaro.

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The authors declare that they have no conflict of interest.


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).

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  • Diet
  • Carbohydrates
  • Fat
  • Glucose control
  • HDL-cholesterol
  • Triglycerides
  • Type 2 diabetes
  • Nutritional guidelines