Skip to main content

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.

This is a preview of subscription content, access via your institution.


  1. Bantle JP, Wylie-Rosett J, Albright AL, Apovian CM, Clark NG, Franz MJ et al (2008) American Diabetes Association. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care 31(Suppl. 1):S61–S78

    CAS  Google Scholar 

  2. Ley SH, Hamdy O, Mohan V, Hu FB (2014) Prevention and management of type 2 diabetes: dietary components and nutritional strategies. Lancet 383:1999–2007

    Article  CAS  Google Scholar 

  3. Heilbronn LK, Noakes M, Clifton PM (1999) Effect of energy restriction, weight loss, and diet composition on plasma lipids and glucose in patients with type 2 diabetes. Diabetes Care 22:889–895

    Article  CAS  Google Scholar 

  4. Dong JY, Zhang ZL, Wang PY, Qin LQ (2013) Effects of high-protein diets on body weight, glycaemic control, blood lipids and blood pressure in type 2 diabetes: meta-analysis of randomized controlled trials. Br J Nutr 110(5):781–789

    Article  CAS  Google Scholar 

  5. Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Sato M et al (2009) Influence of fat and carbohydrate proportions on the metabolic profile in patients with type 2 diabetes: a meta-analysis. Diabetes Care 32:959–965

    Article  CAS  Google Scholar 

  6. Mann JI, De Leeuw I, Hermansen K, Karamanos B, Karlström B, Katsilambros N, The Diabetes and Nutrition Study Group (DNSG), The European Association for the Study of Diabetes (EASD) et al (2004) Evidence based nutritional approaches to the treatment and prevention of diabetes mellitus. Nutr Metab Cardiovasc Dis 14:373–394

    Article  CAS  Google Scholar 

  7. Liese AD, Gilliard T, Schulz M, D’Agostino RB Jr, Wolever TM (2007) Carbohydrate nutrition, glycaemic load and plasma lipids: the Insulin Resistance Atherosclerosis Study. Eur Heart J 28:80–87

    Article  CAS  Google Scholar 

  8. Kirk JK, Craven T, Lipkin EW, Katula J, Pedley C, O’Connor PJ et al (2013) Longitudinal changes in dietary fat intake and associated changes in cardiovascular risk factors in adults with type 2 diabetes: the ACCORD trial. Diabetes Res Clin Pract 100:61–68

    Article  CAS  Google Scholar 

  9. Kirk JK, Graves DE, Craven TE, Lipkin EW, Austin M, Margolis KL (2008) Restricted-carbohydrate diets in patients with type 2 diabetes: a meta-analysis. J Am Diet Assoc 108(1):91–100

    Article  CAS  Google Scholar 

  10. Mayer-Davis EJ, Levin S, Marshall JA (1999) Heterogeneity in associations between macronutrient intake and lipoprotein profile in individuals with type 2 diabetes. Diabetes Care 22:1632–1639

    Article  CAS  Google Scholar 

  11. Nutrition Committee of the British Diabetic Association’s Professional Advisory Committee (1992) Dietary recommendations for people with diabetes: an update for the 1990s. Diabet Med 9:189–202

    Article  Google Scholar 

  12. National Nutrition Committee CDA (1999) Guidelines for the nutritional management of diabetes mellitus in the new millennium: a position statement by the Canadian Diabetes Association. Can J Diabetes Care 23:56–69

    Google Scholar 

  13. Diabetes and Nutrition Study Group, of the European Association for the Study of Diabetes (1995) Recommendations for the nutritional management of patients with diabetes mellitus. Diabetes Nutr Metab 8:186–189

    Google Scholar 

  14. American Diabetes Association (2002) Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care 25:202–212

    Article  Google Scholar 

  15. Krauss RM, Eckel RH, Howard BV, Appel LJ, Daniels SR, Deckelbaum RJ, Erdman JW, Kris-Etherton P, Goldberg IJ, Kotchen TA et al (2000) AHA Guidelines Revision 2000: a statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation 102:2284–2299

    Article  CAS  Google Scholar 

  16. Expert Panel on Detection, Valuation, and Treatment of High Blood Cholesterol in Adults (2001) Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 285:2486–2497

    Article  Google Scholar 

  17. Ajala O, English P, Pinkney J (2013) Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes. Am J Clin Nutr 97:505–516

    Article  CAS  Google Scholar 

  18. Vaccaro O, Masulli M, Bonora E, Del Prato S, Giorda CB, Maggioni AP et al (2012) Addition of either pioglitazone or a sulfonylurea in type 2 diabetic patients inadequately controlled with metformin alone: impact on cardiovascular events. A randomized controlled trial. Nutr Metab Cardiovasc Dis 22(11):997–1006

    Article  CAS  Google Scholar 

  19. Fukuyama N, Homma K, Wakana N, Kudo K, Suyama A, Ohazama H et al (2008) Validation of the Friedewald equation for evaluation of plasma LDL-Cholesterol. J Clin Biochem Nutr 43(1):1–5

    Article  CAS  Google Scholar 

  20. Pala V, Sieri S, Palli D, Salvini S, Berrino F, Bellegotti M et al (2003) Diet in the Italian EPIC cohorts: presentation of data and methodological issues. Tumori 89(6):594–607

    Google Scholar 

  21. Pisani P, Faggiano F, Krogh V, Palli D, Vineis P, Berrino F (1997) Relative validity and reproducibility of a food frequency dietary questionnaire for use in the Italian EPIC centres. Int J Epidemiol 26(Suppl 1):S152–S160

    Article  Google Scholar 

  22. Salvini S, Parpinel M, Gnagnarella P, Maisonneuve P, Turrini A (eds) (1998) Banca dati di composizione degli alimenti per studi epidemiologici in Italia. Istituto Europeo di Oncologia, Milan

    Google Scholar 

  23. Carnovale E, Marletta L (eds) (2000) Tabella di composizione degli alimenti. INRAN

  24. Foster-Powell K, Holt SHA, Brand-Miller JC (2002) International table of glycemic index and glycemic load values: 2002. Am J Clin Nutr 76:5–56

    CAS  Google Scholar 

  25. AMD & SID (2014) Standard Italiani per la cura del diabete mellito. Ed. Infomedica

  26. Van Rompay MI, McKeown NM, Castaneda-Sceppa C, Ordovás JM, Tucker KL (2013) Carbohydrate nutrition differs by diabetes status and is associated with dyslipidemia in Boston Puerto Rican adults without diabetes. J Nutr 143(2):182–188

    Article  Google Scholar 

  27. Wolever TMS, Nguyen P, Chiason J, Hunt JA, Josse RG, Palmason C et al (1995) Relationship between habitual diet and blood glucose and lipids in non-insulin dependent diabetes (NIDDM). Nutr Res 15:843–857

    Article  Google Scholar 

  28. Wheeler ML, Dunbar SA, Jaacks LM, Karmally W, Mayer-Davis EJ, Wylie-Rosett J et al (2012) Macronutrients, food groups, and eating patterns in the management of diabetes. A systematic review of the literature. Diabetes Care 35:434–445

    Article  CAS  Google Scholar 

  29. Rivellese AA, Iovine C, Ciano O, Costagliola L, Galasso R, Riccardi G et al (2006) Nutrient determinants of postprandial triglyceride response in a population-based sample of type II diabetic patients. Eur J Clin Nutr 60:1168–1173

    Article  CAS  Google Scholar 

  30. Chen L, Pei JH, Kuang J, Chen HM, Chen Z, Li ZW, Yang HZ (2015) Effect of lifestyle intervention in patients with type 2 diabetes: a meta-analysis. Metab Clin Exp 64:338–347

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to O. Vaccaro.

Ethics declarations

Conflict of interest

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.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 35 kb)

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: