3.7.0.0 Fats

The ideal amount of di­etary fat for in­di­vid­u­als with di­a­betes is con­tro­ver­sial. The Na­tion­al Acade­my of Medicine has defined an ac­cept­able macronu­tri­ent dis­tri­bu­tion for total fat for all adults to be 20–35% of total calo­rie in­take (104). The type of fats con­sumed is more im­por­tant than total amount of fat when look­ing at metabol­ic goals and CVD risk, and it is rec­om­mend­ed that the per­cent­age of total calo­ries from sat­u­rat­ed fats should be lim­it­ed (75,90,105–107). Mul­ti­ple ran­dom­ized con­trolled tri­als in­clud­ing pa­tients with type 2 di­a­betes have re­port­ed that a Mediter­ranean-‍style eat­ing pat­tern (75,108–113), rich in polyunsat­u­rat­ed and monounsat­u­rat­ed fats, can im­prove both glycemic con­trol and blood lipids. How­ev­er, sup­ple­ments do not seem to have the same ef­fects as their whole-‍food coun­ter­parts. A sys­tematic re­view con­clud­ed that di­etary sup­ple­ments with n-3 fatty acids did not im­prove glycemic con­trol in in­di­vid­u­als with type 2 di­a­betes (84). Ran­dom­ized con­trolled tri­als also do not sup­port rec­om­mend­ing n-3 sup­ple­ments for pri­ma­ry or sec­ondary pre­ven­tion of CVD (114-118). Peo­ple with di­a­betes should be ad­vised to fol­low the guide­lines for the gen­er­al pop­u­la­tion for the rec­om­mend­ed in­takes of sat­u­rat­ed fat, di­etary choles­terol, and trans fat (90). In gen­er­al, trans fats should be avoid­ed. In ad­di­tion, as sat­u­rat­ed fats are pro­gres­sively de­creased in the diet, they should be re­placed with unsat­u­rat­ed fats and not with refined car­bo­hy­drates (112).