M Vitale1, M Masulli1, A A Rivellese1, A C Babini2, M Boemi3, E Bonora4, R Buzzetti5, O Ciano1, M Cignarelli6, M Cigolini4, G Clemente1, G Citro7, L Corsi8, E Dall'Aglio9, S Del Prato10, G Di Cianni11, M A Dolci12, C Giordano13, R Iannarelli14, C Iovine1, A Lapolla15, D Lauro16, S Leotta17, C Mazzucchelli18, V Montani19, G Perriello20, G Romano1, F Romeo21, L Santarelli22, R Schiano di Cola1, S Squatrito23, L Tonutti24, R Trevisan25, A A Turco1, C Zamboni26, G Riccardi1, O Vaccaro27. 1. Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy. 2. Diabetology, Infermi Hospital, Rimini, Italy. 3. UOC Malattie Metaboliche e Diabetologia, INRCA-IRCCS Institute, Ancona, Italy. 4. Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy. 5. UOC di Diabetologia Universitaria, Ospedale Santa Maria Goretti, Latina, Italy. 6. Division of Endocrinology and Metabolism, University of Foggia, Foggia, Italy. 7. UO Endocrinologia e Diabetologia, ASP, Potenza, Italy. 8. SSD Diabetologia e Malattie del Metabolismo, ASL 4 Chiavarese, Genova, Italy. 9. Clinical and Experimental Medicine, University of Parma, Parma, Italy. 10. Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. 11. UOC Diabetologia, ASL 6, Livorno, Italy. 12. UO Diabetologia, USL 1, Massa e Carrara, Italy. 13. Endocrinology and Metabolic Diseases, University of Palermo, Palermo, Italy. 14. UO Diabetologia, Ospedale San Salvatore, L'Aquila, Italy. 15. Department of Medicine, University of Padova, Padova, Italy. 16. Department of Internal Medicine, Tor Vergata University, Rome, Italy. 17. Unit of Diabetology, Sandro Pertini Hospital, Rome, Italy. 18. Department of Internal Medicine, University of Genova, IRCCS San Martino, Genova, Italy. 19. UOSD, Presidio Ospedaliero di Atri, Atri, Italy. 20. MISEM, University of Perugia, Perugia, Italy. 21. Diabetologia, ASL Torino 5, Torino, Italy. 22. Presidio Ospedaliero di Lanciano, Lanciano, Italy. 23. Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy. 24. SOC di Endocrinologia e Malattie del Metabolismo, AOU "S. Maria della Misericordia", Udine, Italy. 25. Endocrinology and Diabetes Unit, AO Papa Giovanni XXIII, Bergamo, Italy. 26. Unità Operativa di Malattie Metaboliche, Dietologia e Nutrizione Clinica, AOU Arcispedale "S. Anna", Ferrara, Italy. 27. Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy. ovaccaro@unina.it.
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.
RCT Entities:
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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