Nutr Res Pract.  2011 Apr;5(2):157-162.

Ratio of fat to energy intake independently associated with the duration of diabetes and total cholesterol levels in type 2 diabetes

• Yim JE
• Kim YS
• Cho MR
• Choue R

Abstract

The importance of dietary intake in the treatment of type 2 diabetes was emphasized. This study was performed to investigate the dietary intakes of Korean type 2 diabetes patients according to the treatment and duration of diabetes and to examine the relationships between their diet and serum lipid profiles. The subjects were 111 type 2 diabetic patients who were treated by medical nutrition therapy only, oral hypoglycemic agents (OHA), or insulin with medical nutrition therapy. Dietary intake was assessed by a registered dietitian using semi-quantitative food frequency questionnaires. Comparisons according to treatment type were made using covariance analyses. General linear models identified the independent effects of the different treatments after covarying for age, duration of diabetes, and 2-way interactions. There were no significant differences in age and BMI but was in duration of diabetes according to treatment type in these subjects. Carbohydrate to energy ratio was higher in the OHA group (P < 0.05), whereas the fat to energy ratio was higher in the insulin group for males (P < 0.05). Carbohydrate (R2 = 0.24, P = 0.005) and fat (R2 = 0.26, P = 0.02) to energy ratios were independently associated with the duration of diabetes after covarying for age, sex, treatment, and 2-way interactions. The levels of triglyceride (TG; R2 = 0.32, P = 0.02) and total cholesterol (TC) were associated independently with energy intake and the carbohydrate (R2 = 0.15, P = 0.02) and fat (R2 = 0.15, P = 0.01) to energy ratios, respectively. The concern that the independent association of dietary intake with either duration of diabetes or dietary factors affects blood lipid levels could suggest that specific dietary recommendations may work better for identifiable groups of diabetes patients.

Keyword

Type 2 diabetes; dietary intakes; treatments; duration of diabetes; blood lipids

MeSH Terms

Cholesterol
Diet
Energy Intake
Humans
Hypoglycemic Agents
Insulin
Linear Models
Male
Nutrition Therapy
Surveys and Questionnaires
Cholesterol
Hypoglycemic Agents
Insulin

Figure

• 

  Fig. 1 Comparision of carbohydrate (-0.3% per 1year) and fat percentages (0.3% per 1 year) from energy with duration of diabetes. CHO: carbohydrate.

Reference

1. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004. 27:1047–1053.

2. 2005 Statistical results about cause of death. 2006. Daejeon: National Statistical Office.

3. Kim YO. Dietary patterns associated with hypertension among Korean males. Nutr Res Pract. 2009. 3:162–166.

4. Kim S, Moon S, Popkin BM. The nutrition transition in South Korea. Am J Clin Nutr. 2000. 71:44–53.

5. Bantle JP, Wylie-Rosett J, Albright AL, Apovian CM, Clark NG, Franz MJ, Hoogwerf BJ, Lichtenstein AH, Mayer-Davis E, Mooradian AD, Wheeler ML. Nutrition recommendations and interventions for diabetes-2006: a position statement of the American Diabetes Association. Diabetes Care. 2006. 29:2140–2157.

6. Albu J, Konnarides C, Pi-Sunyer FX. Weight control: Metabolic and cardiovascular effects. Diabetes Rev. 1995. 3:335–347.

7. Holman RR, Turner RC. Insulin therapy in type II diabetes. Diabetes Res Clin Pract. 1995. 28:S179–S184.

8. Korea National Diabetes Program (KNDP). Guide for type 2 diabetes treatment. 2008.

9. Lindström J, Tuomilehto J, Spengler M. The Finnish Acarbose Study Group. Acarbose treatment does not change the habitual diet of patients with Type 2 diabetes mellitus. Diabet Med. 2000. 17:20–25.

10. Wolever TM, Chiasson JL, Josse RG, Hunt JA, Palmason C, Rodger NW, Ross SA, Ryan EA, Tan MH. No relationship between carbohydrate intake and effect of acarbose on HBA1c or gastrointestinal symptoms in type 2 diabetic subjects consuming 30~60% of energy from carbohydrate. Diabetes Care. 1998. 21:1612–1618.

11. Sanders TA. High- versus low-fat diets in human diseases. Curr Opin Clin Nutr Metab Care. 2003. 6:151–155.

12. Grundy SM, Abate N, Chandalia M. Diet composition and the metabolic syndrome: what is the optimal fat intake? Am J Med. 2002. 113:25S–29S.

13. Hu FB, van Dam RM, Liu S. Diet and risk of Type II diabetes: the role of types of fat and carbohydrate. Diabetologia. 2001. 44:805–817.

14. Heine RJ, Mulder C, Popp-Snijders C, van der Meer J, van der Veen EA. Linoleic-acid-enriched diet: long-term effects on serum lipoprotein and apolipoprotein concentrations and insulin sensitivity in noninsulin-dependent diabetic patients. Am J Clin Nutr. 1989. 49:448–456.

15. Salmerón J, Hu FB, Manson JE, Stampfer MJ, Colditz GA, Rimm EB, Willett WC. Dietary fat intake and risk of type 2 diabetes in women. Am J Clin Nutr. 2001. 73:1019–1026.

16. Samaha FF, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, Williams T, Williams M, Gracely EJ, Stern L. A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med. 2003. 348:2074–2081.

17. Ludwig DS, Pereira MA, Kroenke CH, Hilner JE, Van Horn L, Slattery ML, Jacobs DR Jr. Dietary fiber, weight gain, and cardiovascular disease risk factors in young adults. JAMA. 1999. 282:1539–1546.

18. Salmerón J, Manson JE, Stampfer MJ, Colditz GA, Wing AL, Willett WC. Dietary fiber, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women. JAMA. 1997. 277:472–477.

19. Meyer KA, Kushi LH, Jacobs DR Jr, Slavin J, Sellers TA, Folsom AR. Carbohydrates, dietary fiber, and incident type 2 diabetes in older women. Am J Clin Nutr. 2000. 71:921–930.

20. Lau C, Faerch K, Glumer C, Tetens I, Pedersen O, Carstensen B, Jorgensen T, Borch-Johnsen K. Dietary glycemic index, glycemic load, fiber, simple sugars, and insulin resistance: the Inter99 study. Diabetes Care. 2005. 28:1397–1403.

21. Kim ES, Ko YS, Kim J, Matsuda-Inoguchi N, Nakatsuka H, Watanabe T, Shimbo S, Ikeda M. Food composition table-based estimation of energy and major nutrient intake in comparison with chemical analysis: a validation study in Korea. Tohoku J Exp Med. 2003. 200:7–15.

22. Feuerstein BL, Weinstock RS. Diet and exercise in type 2 diabetes mellitus. Nutrition. 1997. 13:95–99.

23. Rhee BD. Epidemiological Characteristics of Diabetes Mellitus among Korean Population. J Korean Diabetes Assoc. 2003. 27:173–178.

24. American Diabetes Association. Nutrition Recommendations and Interventions for Diabetes: A position statement of the American Diabetes Association. Diabetes Care. 2007. 30:S48–S65.

25. Pittas AG, Roberts SB. Dietary composition and weight loss: can we individualize dietary prescriptions according to insulin sensitivity or secretion status? Nutr Rev. 2006. 64:435–448.

26. McAuley K, Mann J. Thematic review series: patient-oriented research. Nutritional determinants of insulin resistance. J Lipid Res. 2006. 47:1668–1676.

27. Klein S, Sheard NF, Pi-Sunyer X, Daly A, Wylie-Rosett J, Kulkarni K, Clark NG. Weight management through lifestyle modification for the prevention and management of type 2 diabetes: rationale and strategies. A statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition. Am J Clin Nutr. 2004. 80:257–263.

28. Korean Diabetes Association. Korean Treatment Recommendation for diabetes. 2007.

29. Korea Centers for Disease Control and Prevention. The Third National Nutrition Examination Survey (KNHANES III). 2005.

30. Moon SJ. Rice in the Korean diet: a value system. 1993. In : DACO Industrial Research Institute symposium on manufacturing techniques of traditional food utilizing rice; Seoul: DACO Industrial Research Institute.

31. Kim S, Moon SJ, Popkin BM. The nutrition transition in South Korea. Am J Clin Nutr. 2000. 71:44–53.

32. Meyer KA, Kushi LH, Jacobs DR Jr, Slavin J, Sellers TA, Folsom AR. Carbohydrates, dietary fiber, and incident type 2 diabetes in older women. Am J Clin Nutr. 2000. 71:921–930.

33. Bessesen DH. The role of carbohydrates in insulin resistance. J Nutr. 2001. 131:2782S–2786S.

34. McKeown NM, Meigs JB, Liu S, Saltzman E, Wilson PW, Jacques PF. Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring Cohort. Diabetes Care. 2004. 27:538–546.

35. Marshall JA, Hoag S, Shetterly S, Hamman RF. Dietary fat predicts conversion from impaired glucose tolerance to NIDDM. The San Luis Valley Diabetes Study. Diabetes Care. 1994. 17:50–56.

36. Marshall JA, Bessesen DH, Hamman RF. High saturated fat and low starch and fibre are associated with hyperinsulinaemia in a non-diabetic population: the San Luis Valley Diabetes Study. Diabetologia. 1997. 40:430–438.

37. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998. 352:837–853.