Influence of Fat and Carbohydrate Proportions on the Metabolic Profile in Patients With Type 2 Diabetes: A Meta-Analysis
- Satoru Kodama, MD, PHD1,
- Kazumi Saito, MD, PHD1,
- Shiro Tanaka, PHD2,
- Miho Maki, MS1,
- Yoko Yachi, RD1,
- Mutsumi Sato, RD1,
- Ayumi Sugawara, RD1,
- Kumiko Totsuka, RD1,
- Hitoshi Shimano, MD, PHD3,
- Yasuo Ohashi, PHD2,
- Nobuhiro Yamada, MD, PHD3 and
- Hirohito Sone, MD, PHD, FACP1
- 1Department of Lifestyle Medicine and Applied Nutrition, Ochanomizu University, Tokyo, Japan;
- 2Department of Biostatistic, Epidemiology and Preventive Health Sciences, University of Tokyo, Tokyo, Japan;
- 3Endocrinology and Metabolism, University of Tsukuba, Tsukuba, Japan.
- Corresponding author: Hirohito Sone, sone.hirohito{at}ocha.ac.jp
Abstract
OBJECTIVE The effects of dietary macronutrient composition on metabolic profiles in patients with type 2 diabetes have been inconsistent. This meta-analysis aimed to elucidate the effect of replacing dietary fat with carbohydrate on glucose and lipid parameters in patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS We searched for randomized trials that investigated the effects of two kinds of prescribed diets (a low-fat, high-carbohydrate [LFHC] diet and a high-fat, low-carbohydrate [HFLC] diet); in these studies, energy and protein intake did not differ significantly between the two dietary groups. Nineteen studies that included 306 patients met our inclusion criteria. Median diet composition of carbohydrate/fat in the LFHC and HFLC diets was 58%/24% and 40%/40%, respectively.
RESULTS Changes in values for A1C, fasting plasma glucose (FPG), and total and LDL cholesterol did not differ significantly between the LFHC and HFLC groups. However, the LFHC diet significantly increased fasting insulin and triglycerides by 8% (P = 0.02) and 13% (P < 0.001), respectively, and lowered HDL cholesterol by 6% (P < 0.001) compared with the HFLC diet. There were positive associations among the magnitude of changes in FPG, fasting insulin, and triglycerides for the diets analyzed. However, stratified analysis indicated that the increase in triglycerides was insignificant when accompanied by energy intake restriction.
CONCLUSIONS Our findings suggested that replacing fat with carbohydrate could deteriorate insulin resistance while the adverse effect on triglycerides from the LFHC diet could be avoided by restricting energy intake to a degree sufficient for the attainment of weight reduction.
Footnotes
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- Received September 22, 2008.
- Accepted February 4, 2009.
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Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
- © 2009 by the American Diabetes Association.
