title: 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.
abstract: OBJECTIVE
  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.
authors: Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy.
authors: M
authors: M
authors: Vitale
authors: Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy.
authors: M
authors: M
authors: Masulli
authors: Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy.
authors: A A
authors: AA
authors: Rivellese
authors: Diabetology, Infermi Hospital, Rimini, Italy.
authors: A C
authors: AC
authors: Babini
authors: UOC Malattie Metaboliche e Diabetologia, INRCA-IRCCS Institute, Ancona, Italy.
authors: M
authors: M
authors: Boemi
authors: Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy.
authors: E
authors: E
authors: Bonora
authors: UOC di Diabetologia Universitaria, Ospedale Santa Maria Goretti, Latina, Italy.
authors: R
authors: R
authors: Buzzetti
authors: Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy.
authors: O
authors: O
authors: Ciano
authors: Division of Endocrinology and Metabolism, University of Foggia, Foggia, Italy.
authors: M
authors: M
authors: Cignarelli
authors: Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy.
authors: M
authors: M
authors: Cigolini
authors: Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy.
authors: G
authors: G
authors: Clemente
authors: UO Endocrinologia e Diabetologia, ASP, Potenza, Italy.
authors: G
authors: G
authors: Citro
authors: SSD Diabetologia e Malattie del Metabolismo, ASL 4 Chiavarese, Genova, Italy.
authors: L
authors: L
authors: Corsi
authors: Clinical and Experimental Medicine, University of Parma, Parma, Italy.
authors: E
authors: E
authors: Dall'Aglio
authors: Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors: S
authors: S
authors: Del Prato
authors: UOC Diabetologia, ASL 6, Livorno, Italy.
authors: G
authors: G
authors: Di Cianni
authors: UO Diabetologia, USL 1, Massa e Carrara, Italy.
authors: M A
authors: MA
authors: Dolci
authors: Endocrinology and Metabolic Diseases, University of Palermo, Palermo, Italy.
authors: C
authors: C
authors: Giordano
authors: UO Diabetologia, Ospedale San Salvatore, L'Aquila, Italy.
authors: R
authors: R
authors: Iannarelli
authors: Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy.
authors: C
authors: C
authors: Iovine
authors: Department of Medicine, University of Padova, Padova, Italy.
authors: A
authors: A
authors: Lapolla
authors: Department of Internal Medicine, Tor Vergata University, Rome, Italy.
authors: D
authors: D
authors: Lauro
authors: Unit of Diabetology, Sandro Pertini Hospital, Rome, Italy.
authors: S
authors: S
authors: Leotta
authors: Department of Internal Medicine, University of Genova, IRCCS San Martino, Genova, Italy.
authors: C
authors: C
authors: Mazzucchelli
authors: UOSD, Presidio Ospedaliero di Atri, Atri, Italy.
authors: V
authors: V
authors: Montani
authors: MISEM, University of Perugia, Perugia, Italy.
authors: G
authors: G
authors: Perriello
authors: Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy.
authors: G
authors: G
authors: Romano
authors: Diabetologia, ASL Torino 5, Torino, Italy.
authors: F
authors: F
authors: Romeo
authors: Presidio Ospedaliero di Lanciano, Lanciano, Italy.
authors: L
authors: L
authors: Santarelli
authors: Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy.
authors: R Schiano
authors: RS
authors: di Cola
authors: Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
authors: S
authors: S
authors: Squatrito
authors: SOC di Endocrinologia e Malattie del Metabolismo, AOU "S. Maria della Misericordia", Udine, Italy.
authors: L
authors: L
authors: Tonutti
authors: Endocrinology and Diabetes Unit, AO Papa Giovanni XXIII, Bergamo, Italy.
authors: R
authors: R
authors: Trevisan
authors: Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy.
authors: A A
authors: AA
authors: Turco
authors: Unità Operativa di Malattie Metaboliche, Dietologia e Nutrizione Clinica, AOU Arcispedale "S. Anna", Ferrara, Italy.
authors: C
authors: C
authors: Zamboni
authors: Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy.
authors: G
authors: G
authors: Riccardi
authors: Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy. ovaccaro@unina.it.
authors: O
authors: O
authors: Vaccaro
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D002097:C-Reactive Protein / Q000378:metabolism; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D004040:Dietary Carbohydrates / Q000008:administration & dosage*; D004041:Dietary Fats / Q000008:administration & dosage*; D004043:Dietary Fiber / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007249:Inflammation / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014280:Triglycerides / Q000097:blood
chemical_list: D001786:Blood Glucose; D002097:C-Reactive Protein; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004043:Dietary Fiber; D004044:Dietary Proteins; D006442:Glycated Hemoglobin; D014280:Triglycerides
keywords: Carbohydrates; Diet; Fat; Glucose control; HDL-cholesterol; Nutritional guidelines; Triglycerides; Type 2 diabetes