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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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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Carnovale E, Marletta L (eds) (2000) Tabella di composizione degli alimenti. INRAN
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
AMD & SID (2014) Standard Italiani per la cura del diabete mellito. Ed. Infomedica
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
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
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
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
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
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.
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
- Glucose control
- Type 2 diabetes
- Nutritional guidelines