J Korean Diabetes.  2023 Sep;24(3):154-163. 10.4093/jkd.2023.24.3.154.

Diabetes and Dietary Fats

• Cho JW

• KMID: 2546633
• DOI: http://doi.org/10.4093/jkd.2023.24.3.154

Abstract

Fats are important nutrients that supply energy and help to regulate the processes of the human body. The proportion of fat in the energy intake of Koreans, as well as that of saturated fatty acids is continuously increasing. It has been reported that the quality of fat is more important than the intake of fat because of the effects on insulin sensitivity or blood lipid levels depending on the type of fat. To prevent excessive intake of energy or bad fat, total fat intake is recommended to be < 30% of total energy intake. Saturated fatty acids, which have the greatest adverse effect on the risk of cardiovascular disease, are recommended as < 7% of total energy, while trans fatty acids are suggested to be avoided and replaced with unsaturated fatty acids. Emphasis is placed on incorporating healthy eating patterns such as those of the Mediterranean diet and DASH (Dietary Approaches to Stop Hypertension), rich in mono- or polyunsaturated fatty acids. A balanced intake of fatty acids and a variety of nutritional foods in appropriate amounts is important for health.

Keyword

Cardiovascular diseases; Diabetes mellitus; Dietary fats; Dyslipidemias; Fatty acids

Reference

1.Ministry of Health and Welfare; Korean Nutrition Society. 2020 Dietary reference intakes for Koreans. Sejong: Ministry of Health and Welfare;2020. p. 163–202.

2.Song SJ., Shim JE. Evaluation of total fat and fatty acids intakes in the Korean adult population using data from the 2016– 2017 Korea National Health and Nutrition Exam-ination Surveys. Korean J Community Nutr. 2019. 24:223–31.

3.Evert AB., Boucher JL., Cypress M., Dunbar SA., Franz MJ., Mayer-Davis EJ, et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2014. 37(Suppl 1):S120–43.

4.Haffner SM., Lehto S., Rönnemaa T., Pyörälä K., Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and with-out prior myocardial infarction. N Engl J Med. 1998. 339:229–34.

5.van Dam RM., Willett WC., Rimm EB., Stampfer MJ., Hu FB. Dietary fat and meat intake in relation to risk of type 2 diabetes in men. Diabetes Care. 2002. 25:417–24.

6.Bradley U., Spence M., Courtney CH., McKinley MC., Ennis CN., McCance DR, et al. Low-fat versus low-car-bohydrate weight reduction diets: effects on weight loss, insulin resistance, and cardiovascular risk: a randomized control trial. Diabetes. 2009. 58:2741–8.

7.Alhazmi A., Stojanovski E., McEvoy M., Garg ML. Macro-nutrient intakes and development of type 2 diabetes: a systematic review and meta-analysis of cohort studies. J Am Coll Nutr. 2012. 31:243–58.

8.Samaha FF., Iqbal N., Seshadri P., Chicano KL., Daily DA., McGrory J, et al. A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med. 2003. 348:2074–81.

9.Mensink RP., Zock PL., Kester AD., Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipo-proteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr. 2003. 77:1146–55.

10.Vitale M., Masulli M., Rivellese AA., Babini AC., Boemi M., Bonora E, 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. 2016. 55:1645–51.

11.Authors/Task Force Members; ESC Committee for Practice Guidelines (CPG); ESC National Cardiac Societies. 2019 ESC/EAS guidelines for the management of dyslip-idaemias: lipid modification to reduce cardiovascular risk. Atherosclerosis. 2019. 290:140–205.

12.Korean Diabetes Association. 2021 Clinical practice guidelines for diabetes. 7th ed.Seoul: Korean Diabetes Association;2021. p. 56–72.

13.Korean Society of Lipid and Atherosclerosis (KSoLA) Committee of Clinical Practice Guideline. Korean guidelines for the management of dyslipidemia. 5th ed.Seoul: KSoLA;2022. p. 55–67.

14.Imamura F., Micha R., Wu JH., de Oliveira Otto MC., Otite FO., Abioye AI, et al. Effects of saturated fat, polyunsaturated fat, monounsaturated fat, and carbohydrate on glucose-insulin homeostasis: a systematic review and me-ta-analysis of randomised controlled feeding trials. PLoS Med. 2016. 13:e1002087.

15.Eckel RH., Jakicic JM., Ard JD., de Jesus JM., Houston Miller N., Hubbard VS, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014. 129(25 Suppl 2):S76–99.

16.Grundy SM., Stone NJ., Bailey AL., Beam C., Birtcher KK., Blumenthal RS, et al. AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019. 139:e1082–143.

17.Li SX., Imamura F., Schulze MB., Zheng J., Ye Z., Agudo A, et al. Interplay between genetic predisposition, macro-nutrient intake and type 2 diabetes incidence: analysis within EPIC-InterAct across eight European countries. Diabetologia. 2018. 61:1325–32.

18.Mirmiran P., Esfandyari S., Moghadam SK., Bahadoran Z., Azizi F. Fatty acid quality and quantity of diet and risk of type 2 diabetes in adults: Tehran Lipid and Glucose Study. J Diabetes Complications. 2018. 32:655–9.

19.Krishnan S., Steffen LM., Paton CM., Cooper JA. Impact of dietary fat composition on prediabetes: a 12-year fol-low-up study. Public Health Nutr. 2017. 20:1617–26.

20.Nunes EA., Rafacho A. Implications of palmitoleic acid (palmitoleate) on glucose homeostasis, insulin resistance and diabetes. Curr Drug Targets. 2017. 18:619–28.

21.Zong G., Li Y., Sampson L., Dougherty LW., Willett WC., Wanders AJ, et al. Monounsaturated fats from plant and animal sources in relation to risk of coronary heart disease among US men and women. Am J Clin Nutr. 2018. 107:445–53.

22.Dias CB., Amigó N., Wood LG., Mallol R., Correig X., Garg ML. Improvement of the omega 3 index of healthy subjects does not alter the effects of dietary saturated fats or n-6PUFA on LDL profiles. Metabolism. 2017. 68:11–9.

23.Vafeiadou K., Weech M., Altowaijri H., Todd S., Yaqoob P., Jackson KG, et al. Replacement of saturated with unsaturated fats had no impact on vascular function but ben-eficial effects on lipid biomarkers, E-selectin, and blood pressure: results from the randomized, controlled Dietary Intervention and VAScular function (DIVAS) study. Am J Clin Nutr. 2015. 102:40–8.

24.Marklund M., Wu JHY., Imamura F., Del Gobbo LC., Fretts A., de Goede J, et al. Biomarkers of dietary omega-6 fatty acids and incident cardiovascular disease and mortality. Circulation. 2019. 139:2422–36.

25.Geleijnse JM., Giltay EJ., Grobbee DE., Donders AR., Kok FJ. Blood pressure response to fish oil supplementation: metaregression analysis of randomized trials. J Hypertens. 2002. 20:1493–9.

26.Harris WS., Kris-Etherton PM., Harris KA. Intakes of long-chain omega-3 fatty acid associated with reduced risk for death from coronary heart disease in healthy adults. Curr Atheroscler Rep. 2008. 10:503–9.

27.Alexander DD., Miller PE., Van Elswyk ME., Kuratko CN., Bylsma LC. A meta-analysis of randomized controlled trials and prospective cohort studies of eicosapentaenoic and docosahexaenoic long-chain omega-3 fatty acids and coronary heart disease risk. Mayo Clin Proc. 2017. 92:15–29.

28.Miller M., Stone NJ., Ballantyne C., Bittner V., Criqui MH., Ginsberg HN, et al. Triglycerides and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2011. 123:2292–333.

29.Rimm EB., Appel LJ., Chiuve SE., Djoussé L., Engler MB., Kris-Etherton PM, et al. Seafood long-chain n-3 polyunsaturated fatty acids and cardiovascular disease: a science advisory from the American Heart Association. Circulation. 2018. 138:e35–47.

30.ElSayed NA., Aleppo G., Aroda VR., Bannuru RR., Brown FM., Bruemmer D, et al. Facilitating positive health be-haviors and well-being to improve health outcomes: standards of care in diabetes-2023. Diabetes Care. 2023. 46(Supple 1):S68–96.

31.Wei MY., Jacobson TA. Effects of eicosapentaenoic acid versus docosahexaenoic acid on serum lipids: a systematic review and meta-analysis. Curr Atheroscler Rep. 2011. 13:474–83.

32.Mattar M., Obeid O. Fish oil and the management of hy-pertriglyceridemia. Nutr Health. 2009. 20:41–9.

33.Chen C., Yang Y., Yu X., Hu S., Shao S. Association between omega-3 fatty acids consumption and the risk of type 2 diabetes: a meta-analysis of cohort studies. J Diabetes In-vestig. 2017. 8:480–8.

34.Rice Bradley BH. Dietary fat and risk for type 2 diabetes: a review of recent research. Curr Nutr Rep. 2018. 7:214–26.

35.Djoussé L., Gaziano JM., Buring JE., Lee IM. Dietary ome-ga-3 fatty acids and fish consumption and risk of type 2 diabetes. Am J Clin Nutr. 2011. 93:143–50.

36.Brown TJ., Brainard J., Song F., Wang X., Abdelhamid A., Hooper L. Omega-3, omega-6, and total dietary polyunsaturated fat for prevention and treatment of type 2 diabetes mellitus: systematic review and meta-analysis of randomised controlled trials. BMJ. 2019. 366:l4697.

37.Mozaffarian D., Aro A., Willett WC. Health effects of trans-fatty acids: experimental and observational evi-dence. Eur J Clin Nutr. 2009. 63(Suppl 2):S5–21.

38.de Souza RJ., Mente A., Maroleanu A., Cozma AI., Ha V., Kishibe T, et al. Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and me-ta-analysis of observational studies. BMJ. 2015. 351:h3978.

39.National Institute of Food and Drug Safety Evaluation. A in-depth analysis study on intake of nutrients among Korean. Osong: National Institute of Food and Drug Safety Evaluation;2019.

40.Ordovas JM. Genetic influences on blood lipids and cardiovascular disease risk: tools for primary prevention. Am J Clin Nutr. 2009. 89:1509S–17S.

41.Clarke R., Frost C., Collins R., Appleby P., Peto R. Dietary lipids and blood cholesterol: quantitative meta-analysis of metabolic ward studies. BMJ. 1997. 314:112–7.

42.ElSayed NA., Aleppo G., Aroda VR., Bannuru RR., Brown FM., Bruemmer D., American Diabetes Association, et al. 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes-2023. Diabetes Care. 2023. 46(Suppl 1):S158–90.

43.Arnett DK., Blumenthal RS., Albert MA., Buroker AB., Goldberger ZD., Hahn EJ, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019. 140:e596–646.

44.Korean Diabetes Association. 2023 Clinical practice guideline for diabetes (abridgement). 8th ed.Seoul: Korean Diabetes Association;2023. p. 21.

45.Evert AB., Dennison M., Gardner CD., Garvey WT., Lau KHK., MacLeod J, et al. Nutrition therapy for adults with diabetes or prediabetes: a consensus report. Diabetes Care. 2019. 42:731–54.